America's Benefit Specialist October 2023

in a new plan. This is an opportunity for agents and brokers to assist in advancing health equity. Resources HPMS memo announcing race and ethnicity data collection on Medicare Advantage and Part D enrollment form: www.cms.gov/ files/document/hpms-announcement-memo-race-and-ethnici ty.pdf CMS Office of Minority Health: www.cms.gov/about-cms/agen cy-information/omh CMS Framework for Health Equity: www.cms.gov/files/docu ment/cms-framework-health-equity-2022.pdf

• Response to the race and ethnicity questions is optional. Plan enrollment, benefits and premiums will not be affect ed due to the beneficiary’s response or lack of response to the questions. • CMS will continue to explore opportunities for updating, and expanding, race and ethnicity categories in the future. Medicare’s Annual Enrollment Period is coming. Agents and brokers can prepare now to actively engage with bene ficiaries who might have questions about the new race and ethnicity enrollment form questions when it’s time to enroll

MEDICARE ADVANTAGE ENROLLMENT, PLAN AVAILABILITY AND PREMIUMS IN RURAL AREAS

Medicare Advantage enrollment has grown rapidly in recent years and more than half (51%) of all eligible Medicare ben eficiaries are currently in a Medicare Advantage plan. Most Medicare Advantage enrollees, and most Medicare benefi ciaries, live in metropolitan areas. To understand the role of Medicare Advantage in rural areas, the Kaiser Family Foun dation examined trends in enrollment, plan availability and premiums in less-populated counties. In 2023, a smaller share (40%) of Medicare beneficiaries in rural areas—counties with less than 10,000 people—are enrolled in a Medicare Advantage plan than Medicare bene ficiaries in micropolitan (10,000 to 50,000 people) or metro politan (at least 50,000 people) areas (44% and 53%, respec tively). Though Medicare Advantage enrollment is lowest in rural areas, it has grown more rapidly in these counties, nearly quadrupling from 11% of eligible Medicare beneficia ries in 2010 to 40% in 2023. Over the same period, the share of Medicare beneficiaries enrolled in a Medicare Advantage plan in micropolitan areas nearly tripled (from 15% to 44%), and nearly doubled in metropolitan areas (from 27% to 53%). In 2023, more than 1.8 million Medicare beneficiaries in rural areas are enrolled in a Medicare Advantage plan, more than four times the number enrolled in 2010 (400,000). In metropolitan areas, enrollment increased from 9.7 million in 2010 to 26.3 million in 2023 and in micropolitan areas, enroll ment rose from nearly 700,000 in 2010 to 2.6 million in 2023. The growth in enrollment translates into an average annual increase of 12% in rural areas and 11% in micropolitan areas, compared with eight percent in metropolitan areas between 2010 and 2023. Across all areas, the number of Medicare Advantage plans available to the average Medicare beneficiary have risen steadily since 2018, after holding relatively constant in earlier years. In 2023, the average Medicare beneficiary in a rural area has 27 Medicare Advantage plans to choose from, which

is three times more than the number of plans available in 2018 (nine plans). This is similar to the growth in micropolitan areas, where the average Medicare beneficiary has access to 31 plans in 2023, compared to 11 plans in 2018. In contrast, the average Medicare beneficiary in a metropolitan area can choose from substantially more plans—46 in 2023, just over double the number in 2018 (22 plans). Since 2018, the average number of firms offering Medi care Advantage plans has increased in all areas. The average Medicare beneficiary in a rural area can choose from plans offered by six firms in 2023, which is double the number of firms offering plans in these areas in 2018 (three firms). The trend in the number of firms offering plans in micropolitan areas is similar, rising from three in 2018 to six in 2023. The number of firms offering plans has been consistently higher in metropolitan areas than in other geographic areas, rising from six firms in 2018 to 10 firms in 2023. A somewhat smaller share of enrollees in rural (69%) and micropolitan (66%) counties pay no additional premi um compared with enrollees in metropolitan areas (75%). Medicare Advantage plans may impose a premium for the cost of Medicare-covered services above payments made by the federal government to the plans, as well as the cost of prescription drug coverage. Most Medicare Advantage plans offer extra benefits for no additional premium. Since 2015, the share of Medicare Advantage enrollees in plans with no additional premium has increased steadily in all areas. Growth has been fastest in rural areas where the share of enrollees in plans with no additional premium increased from 21% in 2015 to 69% in 2023. Growth has been similarly rapid in micropolitan areas, rising from 24% in 2015 to 66% in 2023. In metropolitan areas, the share of enrollees in plans with no additional premium has been consistently higher than in rural or micropolitan areas, but has increased more slowly, rising from 53% in 2015 to 75% in 2023.

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