In 2020, GIRS spotlighted upcoming Medicare Advantage (MA) growth for 2021. In our recent updates, GIRS continues to track payer growth, specifically in MA payer market as enrollment continues to increase, showing signs of a stable market.
The MA program gives private insurers a chance to sell plans that serve as an alternative to traditional Medicare coverage. In recent years, the MA markets have experienced accelerated growth, reaching a market penetration of about 43% nationally as of March 2021. With more seniors than ever looking to MA to satisfy their health care needs, MA plans have expanded their product selection, offering reduced cost sharing on core medical benefits and attractive supplemental benefits, while also achieving low price points. Increased enrollment in for-profit MA plans drove record-high Medicare Advantage enrollment levels in 2021 with MA plans providing coverage for about 27 million Medicare enrollees by March 2021.
Medicare Advantage Market Penetration
MA market penetration remains strong and there is still abundant opportunity for growth with only 43% of the nearly 63 million people eligible for Medicare enrolled in a MA plan.
The top 10 MA plans have21 million Medicare enrollees, an 11.2% increase from last year, and control78% of the market share with the top three plans controlling 55% of the market share.
While the MA market saw a significant increase in overall enrollment in 2021, the for-profit plans—particularly UnitedHealthcare Medicare Advantage plans—drove that increase. Humana followed UnitedHealthcare. Aetna came in third and Anthem was in fourth place with a single-digit market share. Centene experienced a 30.9 percent growth from last year. This shift was largely the result of Centene’s acquisition of WellCare. The deal added 575,000 MA members to Centene’s enrollment.
Apart from potential trends related to entering new markets, it is not clear why UnitedHealth Group saw such strong membership growth. However, plans with increase in membership share some similar attributes. Attributes of plans with strong memberships are:
Quality Ratings
CMS data revealed that four UnitedHealth Group Medicare Advantage plans received five-star ratings from the Medicare Advantage Star Rating program in 2021. That made UnitedHealth Group the for-profit payer with the highest number of five-star plans in the Medicare Advantage space.
Focus on reduction of out-of-pocket healthcare and emphasis on home healthcare solutions.
For 2021, major for-profit Medicare Advantage payers UnitedHealthcare, Humana, and Cigna—which ranked sixth among for-profit health plans in both 2020 and 2021—focused on reducing out-of-pocket healthcare spending and emphasized home healthcare solutions.
Medicare Advantage Across States
As of March 1, 2021, MA enrollment increased across all states with a net membership gain of nearly 2.4 million. Texas leads all states with a sizeable increase of nearly 208,000members. California, Florida, and Michigan all experienced significant enrollment gains with increases of 100,000 members or more.
What is the Implication of MA Expansion for MedTech? GIRS has worked time and again in the last 19 years with the top MA plans, as well as traditional Medicare, to obtain coverage for our clients’ products and to successfully implement Medicare strategies. As more consumers become Medicare beneficiaries and as Medicare Advantage grows, GIRS is #LookingAheadoftheCurve by educating clients about the potential impact of Medicare enrollment on their payer mix and helping clients redefine payer market access strategies to secure Medicare coverage and preferred status for their products. When contemplating a Medicare strategy for #medtech products, consider both traditional Medicare as well as Medicare Advantage. Let us help you navigate the reimbursement obstacles in the Medicare and MA markets to achieve market access.
Disclaimer: The information in this blog is based on payer information which is dynamic. It is accurate at the time of posting but should not be construed to be reimbursement or legal advice. CPT® is the trademark of the American Medical Association (AMA).
Sources:
- Medicare Advantage Record Growth Expected in 2021- What does this Mean for #Medtech? | Global Integrated Reimbursement Services (GIRS) Blog (reimbursementquestions.com)
- Payer Interest Grows as Medicare Advantage Enrollment Continues to Increase, Showing Signs of a Stable Market | Global Integrated Reimbursement Services (GIRS) Blog (reimbursementquestions.com)
- Year-Over-Year Enrollment Trends for the Medicare Advantage and PDP Senior Markets (markfarrah.com)
- A Dozen Facts About Medicare Advantage in 2020 | KFF
- Centene, WellCare Finalize Major Health Payer Merger Deal (healthpayerintelligence.com)
About GIRS For more than 19 years, GIRS has been assisting medical technology manufacturers with their market uptake and reimbursement strategies so that patients can have access to the care that they need. To implement successful market access strategies, the GIRS Value Discovery Landscape Assessments® team and the Payer Advocacy Compass® team work together to develop and implement foundation reimbursement landscape and payer advocacy strategies to obtain positive coverage, appropriate payment, and innovative payer contracting arrangements to improve market uptake. For more information, email us at info@girsinc.com or call us at 901-834-9119.