KFF released briefs today that explore trends in Medicare Advantage (MA), including out-of-pocket limits, cost sharing, prior authorization, and Star ratings. Here are key findings from the reports.
Three KFF reports provide a snapshot of the MA landscape in 2023, including enrollment trends, quality bonus payments, and premiums, out-of-pocket limits, supplemental benefits, prior authorization, and Star ratings:
- More than half (51 percent) of eligible Medicare beneficiaries are enrolled in MA in 2023.
- Between 2022 and 2023, total MA enrollment grew by about 2.3 million beneficiaries, or eight percent–a similar growth rate to the prior year. The Congressional Budget Office projects that the share of all Medicare beneficiaries enrolled in MA plans will rise to 62 percent by 2033.
- The average Medicare beneficiary can choose from MA plans offered by nine firms in 2023, and four in 10 (40 percent) beneficiaries can choose among MA plans offered by 10 or more firms. However, UnitedHealthcare and Humana account for nearly half of all MA enrollees nationwide.
- More than seven in 10 (73 percent) enrollees in individual MA plans with prescription drug coverage pay no premium other than the Medicare Part B premium, which is a big selling point for beneficiaries.
- Most MA enrollees have access to benefits that are not covered by traditional Medicare, such as vision, hearing, and dental. Plans can offer extra benefits because they are paid $2,350 per enrollee, on average, above their estimated costs of providing Medicare-covered services.
- Nearly all enrollees (99 percent) are in plans that require prior authorization for some services, which is generally not used in traditional Medicare.
- Most MA enrollees are in plans with a quality rating of at least four out of five stars, explained in part by the fact that more than half (51 percent) of plans receive ratings at or above this threshold.
- More than seven in 10 Medicare Advantage enrollees (73 percent) are in plans with no supplemental premium (other than the Part B premium).
- Ninety-seven percent of MA enrollees in individual plans open for general enrollment are in plans that offer prescription drug coverage.
- The average out-of-pocket limit for MA enrollees is $4,835 for in-network services and $8,659 for both in-network and out-of-network services.
- Almost all enrollees in individual MA plans are in plans that provide access to eye exams and/or glasses (more than 99 percent), hearing exams and/or aids (99 percent), a fitness benefit (99 percent), telehealth services (98 percent), and dental care (98 percent).
- Federal spending on MA bonus payments has increased every year since 2015 and will reach at least $12.8 billion in 2023, an increase of nearly 30 percent ($2.8 billion) since 2022.
- Eighty-five percent of MA enrollees are in plans that are receiving bonus payments in 2023.
- The average bonus payment per enrollee is highest for employer- or union-sponsored MA plans ($460) and lowest for special needs plans ($374).
- Bonus payments vary substantially across firms, with UnitedHealthcare receiving the largest total payments ($3.9 billion) and Kaiser Permanente receiving the highest payment per enrollee ($523).