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Year-Over-Year Enrollment Trends for the Medicare Advantage and PDP Senior Markets

March 31, 2021

Health insurers compete by offering new pricing and product options to beneficiaries during the Open Enrollment Period for Medicare Advantage (MA) and prescription drug plans (PDPs), that runs from October 15^th through December 7^th of each year. Plans then begin to analyze final enrollment results in February and March to evaluate their standing and assess which competitors gained and lost members.  As of March 1, 2021, total Medicare Advantage (MA), including Medicare Advantage with Prescription Drug Plan (MA-PD) membership, stood at 27,158,911 with a net gain of 2,408,192 members from March 1, 2020.  Medicare stand-alone prescription drug plans (PDPs) covered 24,268,611 members as of March 1, 2021, a net decrease of 926,333 from the previous year. This brief assesses Medicare Advantage and PDP performance, market share and market penetration by state as of March 1, 2021.

Medicare Advantage (MA) Membership

Medicare Advantage (MA) market penetration remains strong; however, there is still abundant opportunity for growth with only 43% of the nearly 63 million people eligible for Medicare enrolled in a MA plan.  According to CMS Medicare Advantage enrollment reports aggregated by Mark Farrah Associates (MFA) in Medicare Business Online™, total Medicare Advantage plan enrollment as of March 1, 2021 increased 9.7% from March 2020.  The top ten companies, each with more than 250,000 members in this segment, collectively provided coverage for almost 78% of the market.  Per the reference tables below, all leading MA companies realized year-over-year growth with an overall net gain of 11.2%.

MA Leading Plan Performance

UnitedHealth continues to dominate in this highly competitive segment.  With approximately 7.2 million enrolled, UnitedHealth commands 26.6% of the Medicare Advantage market.  Humana ranks second with 18% market share and over 4.8 million lives.  CVS maintains the third position, enrolling over 2.8 million, and Kaiser Foundation Group follows with over 1.7 million lives.

March 2021 Top 10 MA Organizations
Parent	Mar-20	Mar-21	Percent Growth	March 2021 Market Share
UNITEDHEALTH	6,351,706	7,221,432	13.7%	26.6%
HUMANA	4,457,735	4,854,260	8.9%	17.9%
CVS	2,620,469	2,860,379	9.2%	10.5%
KAISER	1,681,235	1,740,733	3.5%	6.4%
ANTHEM	1,326,780	1,530,894	15.4%	5.6%
CENTENE	868,282	1,136,875	30.9%	4.2%
BCBS MI	591,631	608,534	2.9%	2.2%
CIGNA	508,825	568,270	11.7%	2.1%
HIGHMARK	285,142	287,158	0.7%	1.1%
INNOVACARE	263,349	272,421	3.4%	1.0%
Subtotal	18,955,154	21,080,956	11.2%	77.6%
All Others	5,795,565	6,077,955	4.9%	22.4%
Total	24,750,719	27,158,911	9.7%	100.0%
Source: Medicare Business Online, Mark Farrah Associates, presenting data from CMS enrollment reports

The chart below indicates membership gains were considerable for the leaders in this segment. UnitedHealth’s growth continues to raise the bar for MA plan competition. UnitedHealth reported the largest increase in membership, adding approximately 870,000 members year-over-year, for a net gain of 13.7%.  Humana experienced the second largest gains with over 396,000 new members.  Centene and CVS gained over 268,000 and 239,000 new members, respectively.  Centene’s growth of nearly 31% clearly stands out amongst the segment leaders. 

 

MA Organizations with the Largest Gains from March 2020 to March 2021
Parent	Mar-20	Mar-21	Growth 2020-2021	Percent Change
UNITEDHEALTH	6,351,706	7,221,432	869,726	13.7%
HUMANA	4,457,735	4,854,260	396,525	8.9%
CENTENE	868,282	1,136,875	268,593	30.9%
CVS	2,620,469	2,860,379	239,910	9.2%
ANTHEM	1,326,780	1,530,894	204,114	15.4%
KAISER	1,681,235	1,740,733	59,498	3.5%
CIGNA	508,825	568,270	59,445	11.7%
SPECTRUM HEALTH	177,990	202,466	24,476	13.8%
BCBS MN	146,232	164,920	18,688	12.8%
HEALTHFIRST	192,150	210,402	18,252	9.5%
Total	18,331,404	20,490,631	2,159,227	11.8%
Source: Medicare Business Online, Mark Farrah Associates, presenting data from CMS enrollment reports

MA Individual and Group Enrollment

As of March 1, 2021, 82% of membership was from individual MA policies with approximately 22 million enrolled lives.  UnitedHealth Group consistently leads in this sector with over 5.6 million members enrolled in individual MA plans.  In addition to direct purchase policies, nearly 5 million members originated through an employer group health plan or retirement health benefit.  Enrollment in group MA plans continues to grow as these plans allow employers to provide comprehensive medical coverage and quality plan design at lower costs for retirees. Group membership increased by approximately 281,000 members as compared to the same period a year ago. UnitedHealth grew their group enrollment by approximately 187,000, driving the company’s total employer-group membership to over 1.5 million.  CVS's group MA membership stood at 1.1 million, comprising 22.6% of group enrollment as of March 1, 2021.  Humana and Kaiser Foundation Group had more than 540,000 members each from group plans.

MA Plan Types

HMOs, including those with point-of-service options, remain the dominant plan type.  As of March 1, 2021, 15.9 million of all MA members were enrolled in an HMO plan.  PPOs, including local and regional plans, covered approximately 10.3 million MA enrollees.  Enrollment for the dual-eligible population, or Medicare-Medicaid Plans (MMPs), stood at over 389,000 as CMS and state Medicaid agencies continue to build new programs.  Private-fee-for-service (PFFS) and "Other" plan types, including Cost or Medical Savings options, comprised 1.4% of all MA members. 

MA Enrollment Growth by State

As of March 1, 2021, Medicare Advantage enrollment increased in all contiguous states.  Overall, a net membership gain of nearly 2.4 million was seen nationally.  Texas, California, Florida, and Michigan all experienced significant enrollment gains with increases of 100,000 members or more.  Texas experienced the most sizeable year-over-year increase of nearly 208,000 members. 

Stand-alone Prescription Drug Plan (PDP) Enrollment

Stand-alone prescription drug plans (PDPs), also referred to as Medicare Part D stand-alone plans, enrolled approximately 24.3 million people as of March 1, 2021, reflecting a significant decrease of roughly 926,000 enrollees from March 2020.  PDP plans provide prescription drug coverage for nearly 38% of the 63 million people eligible for Medicare.  Enrollment in products sold to individuals was almost 19.5 million in March 2021, a decrease of 773,236, year-over-year.   Only 4.4 million Medicare beneficiaries were enrolled in employer group PDPs as of March 1, 2021, after a decline of approximately 145,444 members since March 2020.  It is important to note this assessment is reporting on Stand-alone PDP members only, and Medicare Advantage with prescription drug plan (MA-PD) members are not included in this analysis.

PDP Leading Plan Performance

There are currently 51 organizations competing in Medicare stand-alone prescription drug plans as of March 2021.  Five companies have greater than 2,000,000 members and command 87% of the PDP market.  As indicated in the chart below, CVS Group, the only top plan to experience membership gains, covers the largest number of people in PDPs and saw a small enrollment increase of 1% between March 2020 and March 2021.

 

March 2021 Top PDP Organizations
Parent	Mar-20	Mar-21	Percent Growth	March 2021 Market Share
CVS	5,681,399	5,738,786	1.0%	23.6%
UNITEDHEALTH	4,847,038	4,507,985	-7.0%	18.6%
CENTENE	4,416,776	4,131,374	-6.5%	17.0%
HUMANA	3,779,400	3,556,348	-5.9%	14.7%
CIGNA	3,303,491	3,194,589	-3.3%	13.2%
Subtotal	22,028,104	21,129,082	-4.1%	87.1%
All Others	3,166,840	3,139,529	-0.9%	12.9%
Total	25,194,944	24,268,611	-3.7%	100.0%
Source: Medicare Business Online, Mark Farrah Associates, presenting data from CMS enrollment reports

PDP Market Penetration by State

Stand-alone prescription drug plan enrollment continued to experience decreases in 45 states within the contiguous U.S. including the District of Columbia as of March 1, 2021.  Texas had the largest year-over-year aggregate decrease with over 67,000 fewer enrollees in this segment.  Alaska, with 66,891 members saw the most sizeable increase of 3,087 more PDP enrollees from the previous year.  South Dakota experienced the second highest enrollment gains with an increase of 2,395 members.    

 

Conclusion

This brief is based on an analysis of enrollment data for Medicare Advantage and Prescription Drug Plans (PDPs) released by the Centers for Medicare & Medicaid Services (CMS).  Mark Farrah Associates’ Medicare Business Online™ simplifies the tracking of monthly Medicare Advantage and PDP enrollment by competitor.  Enrollment data is updated monthly as soon as CMS releases new data.

It is important to note that MA enrollment counts by company or geography for the same reporting period may be slightly different, depending on the CMS enrollment source.  CMS county-level reports do not output enrollment for plans with 10 or fewer members per county.  There may likely be additional competitive shifts in enrollment and market observations through March.   

Many companies conduct their post-OEP competitive assessments by using tools such as Mark Farrah Associates’ (MFA) Medicare Business Online™ and Health Coverage Portal™.  Health insurers continue to invest in MA and PDP growth opportunities for increased enrollment, revenue, and profits as the number of people entering retirement increases each year.  Mark Farrah Associates will continue to monitor plan performance in this highly competitive Medicare segment.

About Mark Farrah Associates (MFA)

Mark Farrah Associates (MFA) is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry. Our product portfolio includes Health Coverage Portal™, County Health Coverage™, Medicare Business Online™, Medicare Benefits Analyzer™, 5500 Employer Health ^PLUS, and Health Plans USA™. For more information about these products, refer to the informational videos and brochures available under the Our Products section of the website or call 724-338-4100.

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