As noted last month, I decided to continue my Medicare Advantage (MA) monthly enrollment blogs because of continuing strong month-over-month increases. Admittedly, the continuing growth is tied to remaining strong benefit packages for 2024 and appears to be isolated to a few big plans.
Many plans will rein in benefits and geographies for contract year 2025 due to significantly deteriorating bottom lines. This is being caused by the return of robust utilization, inflation picking up in the healthcare sector (especially at hospitals), poor Star scores, negative rate increases for 2024 and 2025, and new regulatory burdens (such as the new prior authorization restrictions).
The recent 2024 Star recalculation, which was precipitated by losses in court by the Centers for Medicare and Medicaid Services (CMS), will mean some plans refile bids and benefits for 2025. But we are hearing great reluctance to refile by many due to the quick deadlines, the negative financial position they are in, and uncertainty over what will occur for 2025 Star and rates in subsequent years.
At any rate, let’s look at growth from May to June and growth so far this year. While we are outside of the two regular annual enrollment windows, increases in MA are still strong given the aging of America and the ability of some populations, such as dual eligibles, to continue to make changes throughout the year. As well, new enrollees see huge value in enrolling in MA over the traditional fee-for-service (FFS) program. Whatever the stinginess of benefits in 2025, this value difference will continue to drive growth in 2025, perhaps at lower growth trends.
As I have reported, growth from January 2023 to January 2024 was a robust 8.7% increase or 2.674 million. Enrollment in MA reached 30.799 million in January. Since that time, enrollment has continued to climb:
- By about 183,000 from January 1 to February 1
- By about 144,000 from February 1 to March 1
- By about 86,000 from March 1 to April 1
- By about 100,000 from April 1 to May 1.
- By about 98,000 from May 1 to June 1, about a 0.3% increase.
Enrollment in MA has now hit 34.083 million. The growth from January 1 to June represents an additional approximate 1.8% increase or about 610,000 lives. MA enrollment has now increased beyond 51% of all Medicare beneficiaries.
As we saw with January 2023 to January 2024, PPO growth now significantly outstrips HMO growth. From January 1 to June 1, HMOs grew by about 213,000, with PPOs growing about 392,000. HMOs grew over 44,000 from May to June, with PPOs growing almost 54,000 in that timeframe.
Special Needs Plans (SNPs) continued to do very well too. After growing about 1.154 million from January 2023 to January 2024, SNPs grew by another approximate 211,000 from January to June. Enrollment grew almost 57,000 from May to June.
As was the case year-over-year, many of the Big MA plans continued to struggle. From May to June, again only CVS Health/Aetna and Humana scored major monthly gains.
From January to June, CVS Health/Aetna continued its powerhouse growth, with gains of about 353,000 members. This comes off a January 2023 to January 2024 growth of about 772,000. From January to June, CVS Health/Aetna has registered almost 60% of all growth in the MA program. From May to June, CVS Health/Aetna added almost 48,000 lives.
Humana has rebounded well from a poor open enrollment season. It has added about 106,000 lives from January to June, with almost 21,000 from May to June.
(Note: Molina’s growth is entirely from its acqusition of Bright Health MA lives in mid-January.)
Both CVS Health/Aetna and Humana are expected to rein in benefits in 2025 due to financial pressures. CVS Health/Aetna says its overall enrollment could contract by about 10%.
#medicareadvantage #enrollment #humana #cvshealth #aetna #snps
— Marc S. Ryan
