Despite slowing growth and regulatory headwinds, Medicare Advantage enrollment remains strong and outlook positive

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Mar 05, 2024, 08:00 ET

Report analyzes drivers of continued growth in a mature but still expanding market for Medicare Advantage plans.

CHICAGO, March 5, 2024 /PRNewswire/ -- Chartis, a comprehensive healthcare advisory firm, today announced the release of its annual 2024 Medicare Advantage competitive enrollment report. This year's report is a collaboration between Chartis and HealthScape Advisors, A Chartis Company. Together, they help payers and providers manage transformational change in a rapidly evolving healthcare ecosystem that is increasingly defined by payer-provider convergence.

This year's edition of the report shows that despite strong enrollment gains, market growth appears to be slowing.

The Medicare Advantage market grew by 1.7 million beneficiaries (+5.4%) in 2023, slowing down from the record growth of 2.7 million (+9.4%) in 2022. This ongoing enrollment growth is fueled by an increasing senior market but is overshadowed by regulatory pressures, declining quality scores, and rising medical costs. Notably, for-profit carriers like United, Humana, and Aetna collectively captured 1.4 million new members, representing 86% of the market's growth in the past year. These growth trends come on the heels of a major market milestone of more than 50% of Medicare-eligible individuals enrolling in a Medicare Advantage plan.

According to a Chartis survey representing 19 unique insurers, even with decelerating growth, 79% of plan executives express optimism about the next five years, expecting neutral or positive overall outcomes. And 84% anticipate membership growth equal to or greater than the current year, indicating confidence in the stability and growth potential of the market.

"While the Medicare Advantage market has matured significantly over the past several years, demand for these plans persists because of changing demographics and continued consumer attraction compared to Original Medicare," said Nick Herro, a Chartis Director in Strategic Transformation and co-author of the report. "We are confident demand for Medicare Advantage will hold steady. While plan executives acknowledge the headwinds facing the industry, the majority express optimism about the next five years."

"Health plans have made significant investment to respond to the growth opportunity in this line of business," said Alexis Levy, Managing Director at HealthScape Advisors and report co-author. "But they are now facing challenging market, competitive, and regulatory forces. This new market landscape requires stakeholders to diversify offerings, optimize member engagement, and create sustainable growth and performance."

In addition to top-line enrollment statistics and executive sentiment, Chartis' 2024 Medicare Advantage report analyzed:

Special Needs Plan (SNP) growth: SNP enrollment has surged, adding 1.2 million members. Nearly 7 in 10 new Medicare Advantage enrollees opted for SNPs. This growth is particularly pronounced in Chronic Condition SNPs (C-SNPs). The top 5 plans now represent 77% of the SNP market.
Plan options and preferences: The number of plan options is roughly flat from the previous year, with the average senior having access to 44 plans. In contrast, the trend of the past five years has been 80% growth. Preferred provider organizations (PPOs) have increased, constituting 43% of all plans offered, up from 31% in 2019.
Market dynamics and quality: Medicare Advantage enrollment and social vulnerability are related. Counties with higher vulnerability scores show greater penetration rates (53%) compared to counties with lower scores (45%). Meanwhile, quality remains a concern as plans struggle to maintain quality scores. Average star ratings continued their decline, and this year approximately one-quarter of beneficiaries are enrolled in a plan with less than four stars.
Deeper trends driving the top-line data: The report also digs into trends in Medicare Advantage penetration and growth rates by state, growth patterns in SNPs, plan option trends, market share of for-profit plans, start-up plan growth and membership changes, provider-sponsored health plan enrollment and share growth, and quality ratings performance.

To view the full report, click here.

Methodology
Chartis analyzed Medicare Advantage enrollment, plan, and pricing data from the Centers for Medicare and Medicaid Services (CMS) dated January 2019, January 2020, January 2021, January 2022, March 2023, and January 2024, as well as Medicare fee for service (FFS) enrollment data from CMS, January 2019 to January 2024. The analysis included all Medicare Part C Plans, including Regional PPO and Medicare Cost; certain analyses limited to 50 states and DC Plans categorized as for-profits, Blues, and nonprofit. For market-level analyses, any counties not part of a CBSA (defined by the U.S. Office of Management and Budget) or that had less than 11 Medicare FFS enrollees were excluded. Special Needs Plan (SNP) data was drawn from SNP Comprehensive Reports dated January 2019 to January 2024. Plan options data was drawn from CMS Landscape files 2019 through 2024. Population data was drawn from the U.S. Census Bureau. Chartis survey of 19 health plan executives with P&L responsibility over Medicare Advantage, limited to one per plan. Prior years' reports had limited data to 50 states. This year's report includes new and historical data for US territories, though they are not shown on maps.

About Chartis
The challenges facing US healthcare are longstanding and all too familiar. We are Chartis, and we believe in better. We work with over 900 clients annually to develop and activate transformative strategies, operating models, and organizational enterprises that make US healthcare more affordable, accessible, safe, and human. With over 1,000 professionals, we help providers, payers, technology innovators, retail companies, and investors create and embrace solutions that tangibly and materially reshape healthcare for the better. Our family of brands—Chartis, Jarrard, Greeley, and HealthScape Advisors—is 100% focused on healthcare and each has a longstanding commitment to helping transform healthcare in big and small ways. Learn more.

About HealthScape Advisors
HealthScape Advisors, A Chartis Company is dedicated to helping organizations solve the most challenging business problems in healthcare. HealthScape supports health plans, providers, specialty health companies, investors and innovators as they embark on their most important initiatives, helping them to grow profitably, improve performance and transform their businesses. Purpose-built for healthcare, HealthScape brings its clients a deep and broad understanding of the ever-changing complexities that make up the healthcare marketplace. It is because of this expertise and experience that clients rely on HealthScape as a trusted strategic advisor and thought partner. Learn more.

SOURCE The Chartis Group