Medicare Advantage enrollment growth slowed for 2023

Medicare Advantage growth slowed for the 2023 plan year, according to a report the Chartis Group published Tuesday.

Enrollment increased 5.5% for this year, down from a record 9% the prior year, driven by California and a handful of other states where the number of people signed up for private Medicare plans actually fell, said Nick Herro, a principal at the Chartis Group and co-author of the study.

Health insurance companies devoting marketing efforts to dually eligible Medicare-Medicaid beneficiaries may have contributed to the Medicare Advantage enrollment trend this year, Herro said. Beneficiaries with special needs plans represented two-thirds of the 1.5 million new Medicare Advantage enrollees for 2023. More than 18% of the 29.5 million people with Medicare Advantage have special needs plans.

“There may have been a shift of focus to [special needs] plans, which is a comparatively smaller pool to sell into, that distracted plans from the broader [Medicare Advantage] population,” Herro said.

The market is growing less quickly but some insurers are ahead of the industry at large. For the first time in several years, nonprofit Blue Cross and Blue Shield insurers gained market share. These companies cover 10.2% of Medicare Advantage members and 13% of new customers.

By contrast, other nonprofit insurance companies continued to lose market share to for-profit competitors. In response, nonprofit carriers such as SCAN Group and CareOregon are banding together to strengthen their positions against for-profit and venture capital-backed rivals.

For-profit insurers captured 86% of new members this year. Medicare Advantage heavyweights UnitedHealth Group and Humana continued to lead the market for new customers: UnitedHealthcare signed up 55% of new members and Humana 23% for 2023. The pair hold a combined 78% share of the overall market.

That's despite UnitedHealth Group being barred from selling Medicare Advantage plans in some areas last year because the insurer failed to meet federal medical loss ratio benchmarks. “It’s even more striking that they grew so quickly when you think about that,” Herro said.

CVS Health subsidiary Aetna and Cigna increased sign-ups at slower rates than the total market: Aetna enrollment grew 0.8% and Cigna by 3.4%.

Centene was the only large, for-profit carrier to lose members since last year, as its enrollment dipped by 44,000. The Centers for Medicare and Medicaid Services has forbidden the company from geographically expanding in some regions next year because of poor marks in the Medicare Advantage star ratings program.

“There’s a very clear correlation between quality performance and enrollment performance,” Herro said. “Their star rating change is the most profound and their enrollment change was the most profound.”

Smaller, for-profit insurers Bright Health Group and Alignment Healthcare likewise reported enrollment declines for 2023. Alignment Healthcare offered plans in more areas for this year and yet still receded, Herro said. Nevertheless, sign-ups among health insurance startups grew, led by Devoted Health, although at a slower pace than during the previous years.

Competition in the Medicare Advantage market has deteriorated. Nearly 85% of counties lack competition, especially in rural areas, according the Chartis Group. UnitedHealth Group and Humana’s growth can be attributed with declining competition, the consulting firm reported.

Still, customers have more options than ever. The average Medicare beneficiary had 43 different plans from which to choose or this year, up from 39 in 2022.