During the last decade, Medicare Benefit, the personal plan different to conventional Medicare, has taken on a extra outstanding position within the Medicare program. In 2022, greater than 28 million Medicare beneficiaries are enrolled in a Medicare Benefit plan, almost half of the full Medicare inhabitants. This temporary gives an summary of the Medicare Benefit plans which might be accessible for 2023 and key developments over time. ()
Plan Choices in 2023
Variety of Plans
Variety of Plans Accessible to Beneficiaries. For 2023, the common Medicare beneficiary can select from 43 Medicare Benefit plans, greater than double the common quantity accessible in 2018, and the most important variety of choices accessible over the interval we examined, which fits again to 2010 (Determine 1). These numbers exclude employer or union-sponsored group plans, Particular Wants Plans (SNPs), PACE plans, value plans, and Medicare-Medicaid plans (MMPs) which might be solely accessible to pick out populations.
Of the 43 Medicare Benefit plans accessible for particular person enrollment to the common Medicare beneficiary in 2023, 35 of the plans embrace prescription drug protection (MA-PDs).
Complete Variety of Plans. In complete, 3,998 Medicare Benefit plans can be found nationwide for particular person enrollment in 2023 – a 6 p.c enhance within the variety of plans (228 extra plans) supplied in 2022 and the most important variety of plans accessible over the interval we examined, which fits again to 2010 (Determine 2; Appendix Desk 1). The overwhelming majority (89 p.c) of all Medicare Benefit plans supplied embrace prescription drug protection in 2023.
HMOs account for about six in ten plans (58%) supplied in 2023, a slight decline from 2019 and 2020 the place they accounted for about two-thirds of all plans supplied. The provision of native PPOs has elevated quickly over current years. In 2023, 40% of all Medicare Benefit plans supplied are native PPOs, in comparison with 30% in 2019. The variety of regional PPOs and personal fee-for-service plans (PFFS) have respectively slowly declined from round 2% of plans supplied in 2019 to 1% in 2023.
The expansion in variety of plans varies throughout states and counties, with the preponderance of the expansion occurring in Texas (42 extra plans), Florida (26 extra plans), and Pennsylvania (21 extra plans) (knowledge not proven). In distinction, Washington has 7 fewer plans accessible for 2023 than in 2022, whereas Kansas and Maine have 3 fewer plans; Montana, New Hampshire, Oregon, South Carolina, Utah, Vermont, and the District of Columbia have one fewer plan accessible in 2023 than in 2022. Within the remaining states, the variety of plans both stayed the identical or the expansion in plans was 13 or much less.
Whereas many employers and unions additionally provide Medicare Benefit plans to their retirees, no details about these 2023 plan choices is made accessible by CMS to the general public in the course of the Medicare open enrollment interval as a result of these plans will not be accessible to the final Medicare inhabitants.
Particular Wants Plans (SNPs). In 2023, 1,284 SNPs might be supplied nationwide, an 11 p.c enhance between 2022 and 2023 (Determine 3).
The rise in SNPs for individuals who require an institutional-level of care (I-SNPs) has been significantly notable, almost doubling from 97 plans in 2018 to 189 plans in 2023 (a rise of 5 plans since 2022). I-SNPs could also be engaging to insurers as a result of they have a tendency to have a lot decrease advertising prices than different plan varieties since they’re usually the one accessible possibility for individuals who require an institutional level-of-care, similar to those that have been in nursing houses for an prolonged time period.
The vast majority of SNPs (61%) are plans designed for individuals dually eligible for Medicare and Medicaid (D-SNPs). The variety of D-SNPs has elevated sharply over the previous 5 years, almost doubling from 401 twin SNPs in 2018 to 789 twin SNPs in 2023, suggesting insurers proceed to be drawn to this high-need inhabitants.
The variety of SNPs supplied for individuals with continual circumstances (C-SNPs) can also be rising in 2023 (306 plans), greater than doubling from 2018 (132 plans), most of which concentrate on individuals with diabetes, coronary heart illness, or lung circumstances, as has been the case because the inception of C-SNPs. For 2023, two companies are providing C-SNPs for individuals with dementia (in comparison with three companies in 2022), two companies are providing C-SNPs for individuals with psychological well being circumstances (in comparison with 4 companies in 2022), and one agency is providing a C-SNP for individuals with HIV/AIDS (in comparison with three companies in 2022).
In 2021, individuals with end-stage renal illness (ESRD) grew to become eligible to enroll in Medicare Benefit plans. Previous to this transformation, individuals with ESRD weren’t in a position to enroll in most Medicare Benefit plans, topic to restricted exceptions, similar to C-SNPs for individuals with ESRD. Seven companies are providing C-SNPs for individuals with end-stage renal illness (up three from 2022).
Availability of Insulin Demonstration Plans. In 2023, beneath a provision within the Inflation Discount Act, Half D enrollees can pay not more than $35 per 30 days for coated insulin merchandise in all Half D plans. This new requirement builds on the Half D Senior Financial savings Mannequin established by the Middle for Medicare and Medicaid Improvements (CMMI) in 2021 during which collaborating enhanced Half D drug plans cowl insulin merchandise at a month-to-month copayment of $35 within the deductible, preliminary protection, and protection hole phases of the Half D profit. In 2023, a complete of two,881 Half D plans will take part on this mannequin (a 33% enhance over 2022), together with 324 PDPs and a couple of,557 MA-PDs (together with segmented plans). Whereas this mannequin will proceed in 2023, beneficiaries don’t must enroll in one of many model-participating plans to learn from the $35 month-to-month copay cap for coated insulin merchandise. Beneath the brand new Inflation Discount Act requirement, all Half D plans wouldn’t have to cowl all accessible insulin merchandise on the $35 month-to-month copayment quantity, solely these insulin merchandise which might be coated on a plan’s formulary.
Variation within the Variety of Plans, by Geographic Space. Medicare beneficiaries residing in metropolitan areas can select from 46 Medicare Benefit plans in 2023, on common, considerably greater than the common variety of plans accessible to beneficiaries in non-metropolitan areas (29 plans).
Beneficiaries can select from 75 or extra Medicare plans in 27 counties. Just like final yr, the counties with probably the most plan choices are predominantly in Ohio and Pennsylvania. In Ohio, for instance, beneficiaries can select from 80 or extra Medicare Benefit plans in 10 counties, together with Hamilton County (Cincinnati) and Cuyahoga County (Cleveland). Beneficiaries in Summit County Ohio (Akron) can select from 87 Medicare Benefit plans – probably the most choices of any county within the US. Beneficiaries residing in 4 counties in Pennsylvania may select from 80 or extra plans. In Texas, beneficiaries in Harris County (Dallas) can select from 77 plans and in Michigan, beneficiaries in Oakland County (Detroit) can select from 76 plans (Determine 4).
In 2023, about half of all Medicare beneficiaries (53%) (in 19 p.c of counties), can select from greater than 40 Medicare Benefit plans the place they dwell (Determine 5).
That is in distinction to simply 5 years in the past, in 2018, when fewer than one in ten Medicare beneficiaries (7%) (in lower than 1 p.c of counties) might select from greater than 40 Medicare Benefit plans the place they dwell.
In 2023, in 4 p.c of counties (accounting for 1 p.c of beneficiaries), beneficiaries can select from three or fewer Medicare Benefit plans. The variety of counties with no Medicare Benefit plans for 2023 is 40, a slight lower in comparison with 2022 (65). Just like 2022, two Medicare Benefit plans are being supplied in 15 counties in Alaska. Moreover, no Medicare Benefit plans can be found in territories aside from Puerto Rico. In Puerto Rico, beneficiaries can select from a mean of 37 plans for particular person enrollment and a mean of twenty-two D-SNPs.
Entry to Medicare Benefit Plans, by Plan Sort. As in recent times, nearly all Medicare beneficiaries (99.7%) have entry to a Medicare Benefit plan as an alternative choice to conventional Medicare, together with virtually all beneficiaries in metropolitan areas (99.99%) and the overwhelming majority of beneficiaries in non-metropolitan areas (98.4%). In non-metropolitan counties, a smaller share of beneficiaries have entry to HMOs (91% in non-metropolitan versus 99% in metropolitan counties) or native PPOs (93% in non-metropolitan versus 98% in metropolitan counties), and a barely bigger share of beneficiaries have entry to regional PPOs (77% in non-metropolitan counties versus 72% in metropolitan counties).
Variety of Corporations
The typical Medicare beneficiary is in a position to select from plans supplied by 9 companies in 2023, the identical quantity as in 2022 (Determine 6). Regardless of most beneficiaries gaining access to plans operated by a number of totally different companies, enrollment is concentrated in plans operated by UnitedHealthcare and Humana, and collectively UnitedHealthcare and Humana account for 46 p.c of MA enrollment in 2022.
4 in ten beneficiaries (40%), in 300 counties, are in a position to select from plans supplied by 10 or extra companies or different sponsors. Sixteen companies are providing Medicare Benefit plans in Maricopa, Arizona, and 15 companies are providing Medicare Benefit plans in 4 counties: Pinal and Pima counties in Arizona, and Miami-Dade and Broward counties in Florida. In distinction, 3% of beneficiaries dwell in a county the place three or fewer companies provide Medicare Benefit plans (475 counties). Additional, in 85 counties, most of that are rural counties with comparatively few Medicare beneficiaries (lower than 1% of complete), just one agency will provide Medicare Benefit plans in 2023.
Availability of Plans by Agency and County. UnitedHealthcare and Humana, the 2 companies with probably the most Medicare Benefit enrollees in 2022, have massive footprints throughout the nation, providing plans in most counties. Humana is providing plans in 89 p.c of counties and UnitedHealthcare is providing plans in 84 p.c of counties in 2023, roughly the identical as in 2022 (Determine 7). About 9 in 10 (92%) Medicare beneficiaries have entry to a minimum of one Humana plan and 95 p.c have entry to a minimum of one UnitedHealthcare plan.
Most main Medicare Benefit companies have additionally expanded the variety of counties the place they’re providing plans (Determine 8).
Humana is providing plans in 2,860 counties in 2023, a rise of 123 counties from 2022, whereas UnitedHealthcare is providing plans in 2,709 counties in 2023, a rise of 332 from 2022. Blue Cross Blue Defend Associates are providing plans in 2,466 counties in 2023, a rise of 297 plans from 2022. CVS Well being is providing plans in 1,978 counties, a rise of 138 counties since 2022; Centene is providing plans in 1,739 counties, a rise of 214 counties; and Cigna is providing plans in 581 counties, a rise of 104 counties. Kaiser Permanente is providing plans in 116 counties, the identical as in 2022.
A number of Plan Choices by Corporations within the Similar County. Many Medicare Benefit companies are additionally providing a couple of plan possibility in every county. In 1,136 counties (accounting for 50% of beneficiaries), a minimum of one agency is providing 10 or extra plans for particular person enrollment. For instance, in Bucks and Delaware counties in Pennsylvania, 4 companies are providing 10 or extra plans (Humana, UnitedHealthcare, Blue Cross Blue Defend Associates, and CVS Well being). In 137 counties, two companies are providing 10 or extra plans, and in 63 counties, three companies are providing 10 or extra plans.
Blue Cross Blue Defend Associates are providing probably the most plan choices in a county, with 18 totally different plan choices in seven counties. Humana is providing the subsequent highest variety of plan selections with 16 Medicare Benefit plans accessible in six counties, adopted by CVS, which is providing 13 plan choices in 9 counties. Centene is providing 12 plans choices in seven counties and United Healthcare is providing 11 plan choices in three counties.
New Market Entrants and Exits
In 2023, 8 companies entered the marketplace for the primary time in 2023, collectively accounting for about 6 p.c of the expansion within the variety of plans accessible for common enrollment and about 5 p.c of the expansion in SNPs (Appendix Desk 2). 5 new entrants are providing HMOs accessible for particular person enrollment. 5 of the brand new entrants are providing SNPs; two companies are providing D-SNPs for individuals dually eligible for Medicare and Medicaid, two companies are providing a C-SNP for individuals with choose continual circumstances, and one agency is providing an I-SNP.
Two of the brand new agency entrants are providing plans in California, and the rest are providing plans in Arizona, Connecticut, Iowa, Idaho, Massachusetts, and Missouri.
Eight companies that beforehand participated within the Medicare Benefit market will not be providing plans in 2023. Two of the companies had very low enrollment in 2022, whereas six companies had no enrollment in 2022, together with one which was sanctioned in April 2021 and needed to instantly droop enrollment. Three of the eight exiting companies supplied plans in California.
Premiums
The overwhelming majority of Medicare Benefit plans for particular person enrollment (89%) will embrace prescription drug protection (MA-PDs), and the share of MA-PDs that cost no premium (aside from the Half B premium) has elevated from 59% in 2022 to 66% in 2023. As well as, 17% of Medicare Benefit plans will provide some discount within the Half B premium in 2023. Almost all beneficiaries (99%) have entry to a MA-PD with no month-to-month premium in 2023, just like 2022 (98%). Nevertheless, in Alaska, beneficiaries wouldn’t have entry to a zero-premium MA-PD.
In 2022, 69 p.c of enrollees in MA-PD plans pay no premium aside from the Medicare Half B premium of $170.10 per 30 days. Based mostly on enrollment in March 2022, 13% of enrollees pay a minimum of $50 a month, together with 4 p.c who pay $100 or extra. CMS introduced that the common month-to-month plan premium amongst all Medicare Benefit enrollees in 2023, together with those that pay no premium for his or her Medicare Benefit plan, is predicted to be $18 a month.
Further Advantages
Medicare Benefit plans might present further advantages that aren’t accessible in conventional Medicare, are thought of “primarily well being associated,” and might use rebate {dollars} (together with bonus funds) to assist cowl the price of these further advantages. Starting in 2019, CMS expanded the definition of “primarily well being associated” to permit Medicare Benefit plans to supply extra supplemental advantages. Medicare Benefit plans may prohibit the supply of those further advantages to sure subgroups of beneficiaries, similar to these with diabetes or congestive coronary heart failure, making totally different advantages accessible to totally different enrollees.
Availability of Further Advantages in Plans for Common Enrollment. In 2023, 97% or extra particular person plans provide some imaginative and prescient, health, telehealth, listening to or dental advantages. Although these advantages are broadly accessible, the scope of protection for these companies varies. For instance, a dental profit might embrace cleanings and preventive care or extra complete protection, and sometimes is topic to an annual greenback cap on the quantity coated by the plan. (Determine 9). Plans will not be required to report knowledge about utilization of those advantages or related prices, so it isn’t clear the extent to which supplemental advantages are utilized by enrollees.
As of 2020, Medicare Benefit plans have been allowed to incorporate telehealth advantages as a part of the essential profit package deal – past what was allowed beneath conventional Medicare previous to the COVID-19 public well being emergency. These advantages are proven within the determine above, although their prices are constructed into the bid, and will not be coated by both rebates or supplemental premiums. Moreover, Medicare Benefit plans might provide supplemental telehealth advantages by way of distant entry applied sciences and/or telemonitoring companies, which can be utilized for these companies that don’t meet the necessities for protection beneath conventional Medicare or the necessities for the telehealth advantages as a part of the essential profit package deal (such because the requirement of being coated by Medicare Half B when supplied in-person). The overwhelming majority (97%) of Medicare Benefit plans are providing telehealth in 2023.
Different further advantages which might be ceaselessly supplied for 2023 embrace over-the-counter objects, similar to adhesive or elastic bandages (87%), meal advantages, similar to meal supply (71%), and transportation advantages (43%). Ten p.c of plans provide entry to toilet security gadgets (10%), whereas 4 p.c provide help for caregivers of enrollees or telemonitoring companies (3%). This isn’t an exhaustive listing of additional advantages that plans provide, and plans might present different companies similar to home-based palliative care, therapeutic therapeutic massage, and grownup day well being companies, amongst others.
Availability of Medicare Benefit Plans with Further Advantages. Nearly all Medicare beneficiaries dwell in a county the place a minimum of one Medicare Benefit plan accessible for common enrollment has some further advantages not coated by conventional Medicare, with over 99% gaining access to a minimum of a number of plans with dental, health, imaginative and prescient, and listening to advantages for 2023. The overwhelming majority of beneficiaries even have entry to a number of plans that provide telehealth advantages (over 99%), over-the-counter objects (99%), a meal profit (99%), transportation help (98%) however fewer have entry to a number of plans that provide in-home help companies (87%), toilet security gadgets (70%), or caregiver help (42%).
Availability of Further Advantages in Particular Wants Plans. SNPs are designed to serve a disproportionately high-need inhabitants, and a considerably bigger proportion of SNPs than plans for different Medicare beneficiaries present their enrollees transportation advantages (88%) and in-home help companies (34%). Just like plans accessible for common enrollment, a comparatively small share of SNPs provide help for caregivers (5%) or telemonitoring companies (4%).
Availability of Particular Supplemental Advantages for the Chronically In poor health (SSBCI). Starting in 2020, Medicare Benefit plans have additionally been in a position to provide further advantages that aren’t primarily well being associated for chronically ailing beneficiaries, referred to as Particular Supplemental Advantages for the Chronically In poor health (SSBCI). Data on the supply of SSBCI for 2023 has not but been revealed by CMS, however knowledge on enrollment in 2022 will be discovered right here.
Dialogue
Extra Medicare Benefit plans are being supplied for 2023 than in another yr since 2010, confirming the attractiveness of this marketplace for insurers throughout the nation. The typical Medicare beneficiary has a selection of 43 plans in 2023, supplied by a mean of 9 insurers, a rise within the variety of plans over prior years. Medicare Benefit plans will be engaging to beneficiaries as a result of they usually provide further advantages, similar to dental, imaginative and prescient and listening to, usually for no extra premium, with the trade-off of extra restrictive supplier networks and larger use of value administration instruments, similar to prior authorization. The sheer variety of plans presents each alternatives (to buy higher protection) and challenges (to decipher doubtlessly vital variations throughout plans) though a minority of Medicare Benefit enrollees evaluate plans in the course of the open enrollment interval. Insurers are drawn to the Medicare Benefit market as a result of it’s worthwhile relative to different medical health insurance markets, and this comes at a price to Medicare, in that Medicare at present pays Medicare Benefit 104% of conventional Medicare prices, on common, in keeping with MedPAC. Because the market continues to develop, and enrollment continues to climb, will probably be more and more vital to evaluate how nicely Medicare Benefit is serving beneficiaires when it comes to prices, high quality, advantages and affected person outcomes, in addition to how nicely Medicare’s present fee methodology for Medicare Benefit is working to carry down beneficiary prices and Medicare spending.
Meredith Freed, Jeannie Fuglesten Biniek, and Tricia Neuman are with KFF.
Anthony Damico is an impartial guide.
This evaluation focuses on the Medicare Benefit market in 2023 and developments over time. The evaluation consists of greater than 28 million enrollees in Medicare Benefit plans in 2022.
Knowledge on Medicare Benefit plan availability, enrollment, and premiums have been collected from a set of knowledge recordsdata launched by the Facilities for Medicare & Medicaid Companies (CMS):
In earlier years, KFF had calculated the share of Medicare beneficiaries enrolled in Medicare Benefit by together with Medicare beneficiaries with both Half A and/or B protection. We’ve got modified our method this yr to estimate the share enrolled amongst beneficiaries eligible for Medicare Benefit who’ve each Medicare Half A and Medicare B. These modifications are mirrored in each the 2023 knowledge and in knowledge displayed trending again to 2010. Moreover, in earlier years, KFF had used the time period Medicare Benefit to check with Medicare Benefit plans in addition to different forms of personal plans, together with value plans, PACE plans, and HCPPs. Nevertheless, value plans, PACE plans, HCPPs are excluded from this evaluation along with MMPs. These exclusions are mirrored in each the 2023 knowledge and in knowledge displayed trending again to 2010. KFF’s plan counts could also be decrease than these reported by CMS and others as a result of KFF makes use of total plan counts and never plan segments. Segments usually allow a Medicare Benefit group to supply the “similar” native plan, however might differ supplemental advantages, premium and value sharing in several service areas (usually non-overlapping counties). |