Medicare Advantage Enrollment is up in SoCal and Nationwide, and More Plan Options are Becoming Available

Medicare is big business. The federal government is expected to dole out just over $1 trillion in Medicare expenses in 2023, and that figure is projected to double by 2033.

About 60 million Americans are eligible Medicare beneficiaries and have dozens of options for plans that offer health care and prescription drug benefits. During the Annual Election Period (AEP) - which runs from October 15 to December 7 - enrollees have the choice to change prescription drug plans, enroll in Medicare Advantage plans or return to Original Medicare.

Enrollment changes take effect on January 1. Typically, this is the only period during the year when these plan changes are allowed for most people with Medicare. According to recently released data by the Kaiser Family Foundation (KFF), more than half of eligible Medicare beneficiaries - nearly 31 million people out of 60 million Medicare beneficiaries with both Medicare Parts A and B - are enrolled in Medicare Advantage plans, which supplement original Medicare. Those ratios are slightly higher in California, where enrollment in Medicare Advantage plans accounts for about 55% of the total. Michigan, Alabama and Hawaii lead the nation with 60% enrollment in Medicare Advantage while enrollment is lowest in Wyoming, North Dakota and South Dakota, where the percentage of enrollees in Medicare Advantage is below 20%.

In Southern California, Medicare Advantage enrollment figures surpass statewide averages and are similar to the highest rates of enrollment - plans account for 60% of totals in Los Angeles and Orange Counties. In Riverside and San Bernardino Counties, Medicare Advantage plans represent 72% and 68% of the enrolled population, respectively.

Medicare Advantage plans are attractive to patients because they offer a Medicareapproved plan through a private insurer, an HMO or PPO, that covers both parts A (hospital coverage) and B (medical coverage) versus traditional Medicare benefits, which are administered by the federal government. Medicare pays private insurers a set amount per enrollee per month, which varies by state and county as well as other factors such as the health status of enrollees and estimated costs of covering services offered.

These plans use payments to pay for Medicarecovered services and may include additional benefits such as dental and vision coverage. Medicare Advantage plans may also include a drug plan to lower the cost of prescription medications. On average, private insurers receive $2,350 per enrollee annually above their estimated costs for covered services.

Most plans require no extra premium for coverage and those that are enrolled in plans with additional fees average about $15 per month. That said, there are significant potential out-of-pocket costs. In 2023, the weighted average limit for Medicare Advantage enrollees is $4,835 for in-network services and $8,659 when including out-of-network services, according to KFF research.

Recently, enrollment figures have been bolstered by increasing options. The average Medicare enrollee has access to 43 Medicare Advantage plans in 2023, the largest number of options ever, according to KFFresearch. Nearly two-thirds of Medicare Advantage enrollees nationwide are enrolled in plans generally available to all individuals. Other plans are offered through special needs plans or employer and union-sponsored group plans for retirees.

Special-needs plans, those that are tailored to everything from specific health challenges to geographic or social factors, are one of the fastest growing segments. Enrollment has doubled nationwide for this category since 2018. Despite most beneficiaries having access to many plans, Medicare Advantage enrollment is still highly concentrated among a small number of firms. As Medicare Advantage takes on a more dominant presence in Medicare, and with current payments to plans higher for Medicare Advantage than for traditional Medicare for similar beneficiaries, enrollment in many different plans is projected to increase nationwide.

Additionally, demographics that include an aging population and longer average life expectancy will lead to increased importance and focus on these plans for the U.S. population. Best of all for those shopping for Medicare Advantage plans, the increased demand will create increased options for specialized care in Southern California and beyond.

-David Nusbaum