Medicare Advantage plans gain record hold on the market in 2021, study says

For-profit plans grabbed 85% of new enrollees last year, according to analysis by The Chartis Group.

More older adults bought into Medicare Advantage last year than ever before, with private insurers capturing another 3% of the market from traditional Medicare, a new study says.

Medicare Advantage companies added 2.3 million enrollees in 2021, with 1.3 million of those individuals switching from traditional, fee-for-service Medicare, according to a report released on Thursday by The Chartis Group. At least half of the eligible population in 11 states are now enrolled in Medicare Advantage plans, up from three states last year, the report said.

“There was pretty dramatic growth of MA at traditional Medicare’s expense,” said Nick Herro, co-author of the report and a principal at The Chartis Group.

Forty-five percent of all beneficiaries—or 28 million individuals—are now enrolled in Medicare Advantage plans. Enrollment in special needs plans is driving the growth, with SNP membership growing 20% year-over-year to 4.5 million enrollees, representing 16% of all Medicare Advantage lives. By 2025, report authors expect half of all eligible individuals to choose private insurers to manage their Medicare, with special needs individuals who are eligible for both Medicaid and Medicare accelerating private health plans’ dominance over the traditional, fee-for-service program. National health plans are the largest investors in this space, Herro said.

“The space is attractive because the population is more medically complex,” he said. “There’s this macro theme of value-based care delivery, care management and coordinated risk that really converges on the duals population and the profile of those individuals in those products.”

“SNP product interest is increasing by national plans,” report authors wrote. “This, coupled with robust Medicaid enrollment and eligibility growth, will propel the products forward and lead Medicare Advantage growth.”

For-profit plans continue to capture the lion’s share of new enrollees, with 85% of all members going to private insurers. In 2021, UnitedHealthcare obtained a third of all new enrollment, while Centene acquired 15% of new beneficiaries and CVS Health’s Aetna nabbed 14% of all enrollees, according to the report. Despite these plans’ dominance, the national Medicare Advantage landscape remains competitive, with the number of competitive offerings growing in several states, thanks to for-profit plans trading share year-over-year through aggressive pricing and plan design in local markets.

Report authors pointed to Humana as an example of this phenomenon, with the insurer’s market share declining the most year-over-year, despite the nation’s second-largest Medicare Advantage carrier adding 315,000 new members.

Not-for-profits and Blue Cross Blue Shield plans likewise ceded more of their market share to for-profit plans. Report authors pointed out that private insurers’ share of enrollment has grown 11.3% since 2019, while Blues plans have grown 5.5% and not-for-profits have grown 4% during that time frame. Kaiser Permanente can serve as an example of this trend, according to report authors, with the not-for-profit’s hold on the market declining at the second-fastest rate in 2021.

“In a market that’s growing 9% per year, you can lose share and still feel good about it,” Herro said. “If you’re growing at 4 or 5% a year, that’s actually by most accounts, a very successful growth rate.”

Insurtechs also grew their influence in the lucrative market last year, capturing 1.3% of all new enrollees in 2021, up from 0.9% the year before. Bright Health Group and Devoted Health led the way among startup insurers, with the two companies representing two-thirds of growth among this cohort. As these companies continue to expand their geographic footprint and grow through targeted mergers over the new fest years, young health plans “could quickly change the competitive landscape” and grab share from the for-profits, Herro said.

He added that the Blues and not-for-profits could learn from the insurtech’s go-to-market strategy.

“These plans very confidently moved into many markets very quickly, developed attractive products, marketed them correctly and you see the benefit of that,” Herro said.