54% of Medicare eligibles enrolled in MA for 2024: KFF

By Paige Minemyer / August 12, 2024

Fifty-four percent of Medicare beneficiaries are enrolled in a private Medicare Advantage (MA) plan, and, in seven states, that figure tops 60%, according to a new report from KFF.

That's about 32.8 million people in the Medicare eligible population who had signed up for MA as of 2024.

The analysts found that in Alabama, Connecticut, Michigan, Hawaii, Maine, Florida and Rhode Island, enrollment in MA is 60% or more, reaching a high of 63%. More than half of Medicare eligibles are enrolled in MA across 30 states, according to the report.

Meanwhile, enrollment is fairly low in 13 states, including five where MA accounts for fewer than 30% of Medicare lives. Four of those five states—Alaska, North Dakota, South Dakota and Wyoming—are largely rural, with the fifth, Maryland, an outlier.

MA enrollment also accounts for more than 60% of the population in Puerto Rico, according to the report. Just 10 years ago, there were no states in which MA accounted for more than 50% of Medicare enrollment.

As MA enrollment climbs, there is greater scrutiny on costs associated with the program and how well it's working for beneficiaries. Research largely suggests that MA plans are paid more for members than those costs would be in traditional Medicare, according to KFF.

A report from the Medicare Payment Advisory Commission (MedPAC) released earlier this year found that MA plans receive payments from the Centers for Medicare & Medicaid Services equal to about 122% of what beneficiaries in traditional Medicare spent.

"As Medicare Advantage takes on a more dominant presence in the Medicare program, and with current payments to plans higher for Medicare Advantage than for traditional Medicare for similar beneficiaries, policymakers have become increasingly focused on how well Medicare’s current payment methodology for Medicare Advantage is working to enhance efficiency and hold down beneficiary costs and Medicare spending," the KFF analysts wrote.

The KFF study found that about one-third, or 37%, of Medicare beneficiaries live in a county where 60% or more are enrolled in MA. In three counties—Monroe County, New York; Starr County, Texas; and Miami-Dade County, Florida—MA enrollment tops 80% of all Medicare eligibles.

The MA space is also highly concentrated among several key players, the study notes. About half (47%) of all MA enrollees are in a plan either through UnitedHealthcare or Humana. In 29% of U.S. counties, these two insurers account for at least 75% of all MA enrollment, the study found.

Since 2017, UHC and CVS Health have both grown their market share, according to the report. with UnitedHealth's share growing from 25% to 29% in 2024. Humana and Cigna, by comparison, held steady on their market share, while Blue Cross Blue Shield Plans, Kaiser Permanente and Centene saw declines in their share of the market.

Smaller firms, KFF researchers said, individually account for less than 2% of enrollment. Their collective market share has shrunk from 19% to 16% since 2024, according to the report.