America's Benefit Specialist April 2023

MEDICARE MATTERS

IN A SHIFTING MARKET, MEDICARE ADVANTAGE SHOWS CONTINUED GROWTH Tailwinds that have propelled Medicare Advantage popu larity persist as we look at the 2023 plan year. Despite some tumult in the market—from changes to the Risk Adjustment Data Validation (RADV) program, actions from CMS for select plans, and some headline-grabbing retreats from start-up plans—this year saw record enrollment and pushed program penetration past 46%. While more modest than last year’s growth, this year’s growth increased overall Medicare Ad vantage program participation by 5.5% and added 1.5 million beneficiaries. A total of 29.5 million beneficiaries are now enrolled in a Medicare Advantage plan. The Medicare Advantage market features a complex and continuously changing landscape of competition for eligible beneficiaries. The competitive complexity and changes have far-reaching implications not only for the health plans that serve these members directly but also for healthcare services organizations (such as value-based primary care practices) whose businesses are built on serving this important seg ment. Notably, this year: The pace of Medicare Advantage growth itself is slowing. In 2020, 2021 and 2022, we saw Medicare Advantage enrollment grow by 1.9 million, 2.2 million and 2.3 million beneficiaries, respectively. This year, Medicare Advantage enrollment grew by just 1.5 million. This is still remarkable growth, but it does point to a deceleration. At the same time, Original Medicare continues to decline, losing 339,000 enrollees this year—a sig nificant but smaller loss than previous years. Special Needs Plans (SNP) enrollment accounted for two-thirds of total market growth. SNP enrollment is up 20% from 2022, driven by considerable D-SNP enrollment gains. Blues plans may be regaining their footing, but United leads growth with record enrollment. For the first time in many years, nonprofit Blues plans notched a market share gain of 0.2%. While modest, this increase sits in stark contrast to remaining nonprofit plans, which saw a 0.8% share decline,

continuing prior years’ losses. Conversely, for-profit United ac counted for a staggering 55% of all new enrollment. In prior years,

this hovered in the 30% to 40% range. Humana accounted for 23% of all new enrollment, meaning the two health plans com bined represent four in five new enrollees nationally. Start-up plans continue to grow, although their advances have slowed. Overall, start-up plans participating in Medicare Advantage that we have tracked notched seven percent growth this year. This growth exceeds the market average but pales in comparison to their prior years’ stratospheric annual membership growth (+25%). Their current share of the market now sits at 1.7%. Three states and the District of Columbia saw enrollment declines. This is the first time in recent history that we have seen enrollment declines in key states. Meanwhile, 15 states now boast Medicare Advantage enrollment rates at or ex ceeding 50%. Plan options have reached an all-time high, but health plan competition is limited. Plan options for consumers have been growing more than 11% per year. This year, the average member had access to 43 different plan options, up from 24 in 2019 (a growth of nearly 80%). Despite this, at the county level, competition in the market continues to deteriorate. Nearly 85% of counties are considered “highly concentrated.” Quality performance correlates to enrollment performance. 73% of Medicare Advantage beneficiaries are enrolled in health plans receiving 4+ stars this year, down from 89% the year prior. Health plans that saw their quality rating increase realized 9.6% enrollment gains, despite only 3.5% growth for health plans that saw their ratings decline this year. For more information, visit www.chartis.com/insights/ shifting-market-medicare-advantage-shows-continued- growth. government red tape separating patients from the care they need, especially in rural communities.” “It is clear we need more options and innovation in health care, not less,” said Lankford. “The Affordable Care Act unfair ly prohibits the creation and expansion of physician-owned hospitals, reducing yet another healthcare access point for Oklahomans and people around the country, particularly those on Medicare and Medicaid. My bill removes the ACA’s ban on POHs and allows them to offer innovative services that can be tailored to meet patients’ needs. We can and

SENATORS PUSH FOR GREATER HEALTHCARE ACCESS U.S. Senators Bill Cassidy, M.D. (R-LA) and James Lankford (R OK) recently introduced the Patient Access to Higher Quality Health Care Act. The bill removes the Affordable Care Act’s ban on the creation and expansion of new physician-owned hospi tals and allows POHs to participate in Medicare and Medicaid. Lifting this ban will increase competition among hospitals, decrease costs, and expand access to quality care for more Americans, especially those with Medicare and Medicaid.

“As a doctor, getting the best care to patients is always the priority,” said Cassidy. “This bill reduces the amount of

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