Dive Temporary:
- Medicare Benefit markets are extremely concentrated, leaving many beneficiaries with few selections for insurers at the same time as enrollment within the privatized Medicare program climbs, in keeping with an evaluation revealed Monday by the KFF.
- Final yr, 9 in 10 Medicare enrollees lived in a county the place no less than half of MA beneficiaries have been coated by plans sponsored by only one or two insurers, the well being coverage researcher discovered.
- Main MA insurers UnitedHealthcare or Humana had the most important market share in two-thirds of counties, making up almost 60% of complete MA enrollment in 2024.
Dive Perception:
Extra seniors are selecting MA plans, the place the federal authorities pays personal insurers a set quantity to handle healthcare for Medicare beneficiaries.
MA enrollees have entry to 34 plans with prescription drug protection on common this yr, double the quantity on provide in 2018, in keeping with the KFF. Nevertheless, the variety of insurers sponsoring these plans solely barely elevated throughout this time, suggesting these payers aren’t working in a aggressive market.
Final yr, almost 80% of counties have been thought-about extremely concentrated MA markets, whereas one other 18% have been very extremely concentrated. Solely 30 counties, or lower than 1% of the full, have been reasonably concentrated, in keeping with the KFF evaluation. None have been unconcentrated.
Beneficiaries in rural areas have fewer MA insurer choices. Practically 40% of essentially the most rural counties have been extremely concentrated, in contrast with simply 15% of rural areas close to city counties and 6% of city counties.
The big market share managed by UnitedHealthcare and Humana was significantly pronounced within the least aggressive markets. UnitedHealthcare was the most important MA insurer in half of very extremely concentrated counties and 41% of extremely concentrated counties final yr.
In the meantime, Humana was the most important MA insurer in 22% of very extremely concentrated counties and 26% of extremely concentrated areas, the KFF discovered.
MA has come below elevated scrutiny from lawmakers and regulators for driving up prices within the Medicare program.
MedPAC, which advises Congress on Medicare coverage, estimates the federal authorities will spend $84 billion extra on MA enrollees this yr than it will if these beneficiaries have been enrolled in conventional fee-for-service Medicare, partially resulting from upcoding, the place insurers exaggerate members’ well being wants to extend reimbursement.
The CMS moved to increase audits on MA plans to catch overpayments in Could, after Administrator Dr. Mehmet Oz promised to extra closely scrutinize this system.
Nonetheless, this spring the Trump administration finalized MA cost charges for 2026 that have been considerably larger than the Biden administration had earlier proposed, partially resulting from newer information of rising prices.
