Year-Over-Year Medicare Advantage and Prescription Drug Plan Enrollment Trends

March 29, 2022

Health insurers compete by offering new pricing and product options to beneficiaries during the Open Enrollment Period (OEP) 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, 2022, total Medicare Advantage (MA), including Medicare Advantage with Prescription Drug Plan (MA-PD) membership, stood at 29,476,811 with a net gain of 2,317,900 members from March 1, 2021. Medicare stand-alone prescription drug plans (PDPs) covered 23,444,389 members as of March 1, 2022, a net decrease of 824,222 members from the previous year. This brief assesses Medicare Advantage and PDP performance, market share and market penetration by state as of March 1, 2022.

Medicare Advantage (MA) Membership

Medicare Advantage (MA) market penetration remains strong; however, there is still abundant opportunity for growth with only 46% of the nearly 63.9 million people eligible for Medicare enrolled in a MA plan. According to Centers for Medicare & Medicaid Services (CMS), Medicare Advantage enrollment reports aggregated by Mark Farrah Associates (MFA) in Medicare Business Online™, total Medicare Advantage plan enrollment as of March 1, 2022, increased 8.5% from March 2021. The top ten companies, each with more than 270,000 members in this segment, collectively provided coverage for almost 80% of the market. Per the reference tables below, all leading MA companies realized year-over-year growth with an overall net gain of 10.3%.

MA Leading Plan Performance

UnitedHealth Group continues to dominate in this highly competitive segment. With almost eight million enrolled, UnitedHealth commands 27.1% of the Medicare Advantage market. Humana ranks second with 17.4% market share and over 5.1 million lives. CVS maintains the third position, enrolling over 3.1 million, and Anthem follows with over 1.9 million lives.

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 762,000 members year-over-year, for a net gain of 10.5%. Anthem experienced the second largest gains with over 376,000 new members. Centene and CVS gained over 319,000 and 298,000 new members, respectively. Centene’s growth of 28% clearly stands out amongst the segment leaders.

MA Individual and Group Enrollment

As of March 1, 2022, 83% of membership was from individual, or direct purchase MA policies with over 23 million enrolled lives.  UnitedHealth Group consistently leads in this sector with over 6.25 million members enrolled in individual MA plans. In addition to direct purchase policies, approximately 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 158,000 members as compared to the same period a year ago. UnitedHealth grew its group enrollment by approximately 155,000, driving the company’s total employer-group membership to over 1.6 million. CVS's group MA membership stood at 1.1 million, comprising 36% of group enrollment as of March 1, 2022. Humana and Kaiser Foundation Group had more than 550,000 members each from group plans and Anthem reported almost 208,000 covered Group MA lives.    

MA Plan Types

HMOs, including those with point-of-service options, remain the dominant plan type.  As of March 1, 2022, 16.8 million of all MA members were enrolled in an HMO plan.  PPOs, including local and regional plans, covered approximately 11.5 million MA enrollees. Enrollment for the dual-eligible population, or Medicare-Medicaid Plans (MMPs), stood at over 418,000 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 less than 1% of all MA members. 

MA Enrollment Growth by State

 

As of March 1, 2022, Medicare Advantage enrollment increased in all contiguous states.  Overall, a net membership gain of over 2.3 million was seen nationally. Texas, Florida, California, Illinois, North Carolina New York all experienced significant enrollment gains with increases of 100,000 members or more. Texas experienced the most sizeable year-over-year increase of over 172,000 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 23.4 million people as of March 1, 2022, reflecting a significant decrease of roughly 824,000 enrollees from March 2021. PDP plans provide prescription drug coverage for nearly 37% of the 63.8 million people eligible for Medicare. Enrollment in products sold to individuals was almost 18.8 million in March 2022, a decrease of around 637,000, year-over-year. Only 4.2 million Medicare beneficiaries were enrolled in employer group PDPs as of March 1, 2022, after a decline of approximately 144,000 members since March 2021.  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 2022.  Five companies have greater than 2.9 million members and command 88.5% of the PDP market.  As indicated in the chart below, CVS Group covers the largest number of people in PDPs, with 6 million members, and saw an enrollment increase of 5.3% between March 2021 and March 2022.  Centene also saw year-over-year enrollment gains and ranks second, with approximately 4.2 million members, commanding 18% of the market.

PDP Market Penetration by State

Stand-alone prescription drug plan enrollment continued to experience decreases in most states within the contiguous U.S. including the District of Columbia as of March 1, 2022 with the exception of South Dakota, Alaska, Wyoming, and Montana. South Dakota, with 111,657 PDP members, saw the most sizeable increase of 1,713 more enrollees from the previous year. Alaska experienced the second highest enrollment gains with an increase of 1,387 members. Illinois, which has almost 994,000 PDP members, had the largest year-over-year aggregate decrease with over 66,000 fewer enrollees in this segment. 

About Medicare Business Online

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 the 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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