On Medicare Advantage Plans (Private Medicare)

PART C

By John Kelly

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Medicare Advantage Plans (Private Medicare) are sold on a county-by-county basis. Attached is the market penetration of MA (compared to traditional FFS Medicare) for every county in the USA.

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Wonder why Medicare Advantage Premiums are going down (on average)? Because premiums are one of the measures by which the elderly decide what to purchase. Even though premiums are declining, not all MA plans are ‘cheaper’ than traditional FFS Medicare. Caveat Emptor.

It is also interesting to note that 3 carriers – Humana, UHC and BCBS Affiliates — cover 60% of all MA plan subscribers and use national networks of providers to offer broad service availability (compared to smaller plans, PSP’s and other narrow network options).

Medicare premiums per beneficiary typically exceed $10,000 per year. With effective ingenious use of benefit design, prior authorization, incentives, PBM contract rebates, etc., — there is a lot of money to be made in Medicare Advantage plans — accounting for the rapid growth in these plans over the last decade.

3 Responses

  1. Q2 Membership in Medicare Advantage Plans Reached 24.8 Million

    Mark Farrah Associates recently released an analysis of health insurance enrollment updates for the second quarter. Here are some key findings from the report:

    • Insurance companies provided medical coverage for 274 million people as of June 30, 2020.
    • Over 15.3 million people are currently enrolled in Individual, Non-Group medical plans (2.8% growth).
    • Managed Care Organizations provide coverage for approximately 52.8 million beneficiaries (6% growth).
    • Second quarter membership in Medicare Advantage plans increased to over 24.8 million.

    Source: Mark Farrah Associates, October 6, 2020

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  2. Employer-Group Medicare Advantage Plan Membership Rose 4.7% Since 2019

    Mark Farrah Associates recently released an analysis of employer-group Medicare Advantage (MA) membership trends. Here are some key findings from the report:

    • As of October 1, 2020, 4.7 million members were enrolled in employer-group MA plans.
    • 5 carriers covered 85% of all enrollees, with UnitedHealth leading with 1.3 million members.
    • California maintained the highest number of employer-group MA members with 645,847.
    • 209,000 more beneficiaries were enrolled in employer-group MA plans than in 2019, a 4.7% increase.

    Source: Mark Farrah Associates, November 17, 2020

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