Medicare Advantage 2022 Spotlight: First Look
Over the last decade, Medicare Advantage, the private plan alternative to traditional Medicare, has taken on a larger role in the Medicare program. In 2021, more than 26 million Medicare beneficiaries are enrolled in a Medicare Advantage plan. This brief provides an overview of the Medicare Advantage plans that are available for 2022 and key trends over time. (A separate overview of the 2022 Medicare Part D marketplace is also available.)
Plan Offerings in 2022
Number of Plans
Number of Plans Available to Beneficiaries. For 2022, the average Medicare beneficiary has access to 39 Medicare Advantage plans, more than double the number of plans per person in 2017, and the largest number of options available in more than a decade (Figure 1). These numbers exclude employer or union-sponsored group plans, Special Needs Plans (SNPs) and PACE plans, which are only available to select populations.
Among the 39 Medicare Advantage plans generally available for individual enrollment to the average Medicare beneficiary, 31 of the plans include prescription drug coverage (MA-PDs).
Total Number of Plans. In total, 3,834 Medicare Advantage plans are available nationwide for individual enrollment in 2022 – an 8 percent increase (284 more plans) from 2021 and the largest number of plans available in more than a decade (Figure 2; Appendix Table 1). The vast majority (89 percent) of all Medicare Advantage plans offered include prescription drug coverage in 2022.
HMOs account for about six in ten (59%) of all plans offered in 2022, a slight decline from prior years where they accounted for about two-thirds of all plans offered. The availability of local PPOs has increased rapidly over recent years. In 2022, more than one-third of plans (37%) offered are local PPOs, compared to a quarter in 2018. Between 2021 and 2022, the number of regional PPOs has remained constant, while the number of private fee-for-service plans has continued to decline.
The growth in number of plans varies across states and counties, with the preponderance of the growth occurring in Texas and Florida (41 more and 32 more plans, respectively; data not shown). Alaska has two plan offerings for the first time since 2010. Arkansas has 8 fewer plans available for 2022 than in 2021, while Kentucky has 6 fewer plans, Washington and Ohio each have three fewer plans, and Tennessee has two fewer plans available in 2022 than in 2021.
While many employers and unions also offer Medicare Advantage plans to their retirees, no information about these 2022 plan offerings is made available by CMS to the public during the Medicare open enrollment period because these plans are not available to the general Medicare population.
In 2021, people with end-stage renal disease (ESRD) became eligible to enroll in Medicare Advantage plans. Prior to this change, people with ESRD were not able to enroll in most Medicare Advantage plans, subject to limited exceptions, such as C-SNPs for people with ESRD. In 2021, only about 4,800 Medicare Advantage enrollees were in a C-SNP for people with ESRD.
Availability of Insulin Demonstration Plans. In 2022, beneficiaries in each state will have the option to enroll in a Part D plan participating in an Innovation Center model in which enhanced drug plans cover insulin products for non-LIS enrollees at a monthly copayment of $35 in the deductible, initial coverage, and coverage gap phases of the Part D benefit. In 2022, a total of 2,159 Part D plans will participate in this model, including 1,901 MA-PDs (38% of MA-PDs, including segmented plans).
Special Needs Plans (SNPs). More SNPs are available for 2022 than in any year since they were authorized, increasing from 975 plans in 2021 to 1,156 plans in 2022, a 19 percent increase (Figure 3).
The rise in SNPs for people who require an institutional-level of care (I-SNPs) has been particularly notable, more than doubling from 83 plans in 2017 to 184 plans in 2022 (an increase of 10 plans since 2021). I-SNPs may be attractive to insurers because they tend to have much lower marketing costs than other plan types since they are often the only available option for people who require an institutional level-of-care, such as those who have been in skilled nursing facilities or nursing homes for 90 days or longer. The number of SNPs for people dually eligible for Medicare and Medicaid (D-SNPs) has also increased sharply over the past five years, nearly doubling from 373 dual SNPs in 2017 to 700 dual SNPs in 2022, suggesting insurers’ continue to be interested in managing the care of this high-need population.
The number of SNPs offered for people with chronic conditions (C-SNPs) is also increasing in 2022 (272 plans), more than doubling from 2017 (122 plans), most of which focus on people with diabetes, heart disease, or lung conditions, as has been the case since the inception of C-SNPs. For 2022, three firms are offering C-SNPs for people with dementia (the same as 2021), four firms are offering C-SNPs for people with mental health conditions (up two from 2021), four firms are offering C-SNPs for people with end-stage renal disease (up one from 2021) and two firms are offering C-SNPs for people with HIV/AIDS (same as 2021).
Variation in the Number of Plans, by Geographic Area. On average, beneficiaries in metropolitan areas can choose from many more Medicare Advantage plans than beneficiaries in non-metropolitan areas (42 plans versus 25 plans, respectively).
In the top 25 counties in terms of plan offerings, beneficiaries can choose from 66 or more Medicare plans, including 14 counties in Ohio and 7 counties in Pennsylvania. Summit County in Ohio offers the most Medicare Advantage plans in 2022, at 82 (Figure 4).
In 5 percent of counties (accounting for 25% of beneficiaries), beneficiaries can choose among more than 50 Medicare Advantage plans, including 51 counties with more than 60 plans (Figure 5). In contrast, in 4 percent of counties (accounting for 1% of beneficiaries), beneficiaries can choose from three or fewer Medicare Advantage plans. The number of counties with no Medicare Advantage plans for 2021 is 65, a slight decrease compared to 2021 (82). For the first time since 2010, two Medicare Advantage plans are being offered in 15 counties in Alaska. Additionally, no Medicare Advantage plans are available in territories other than Puerto Rico. In Puerto Rico, beneficiaries can choose from an average of 26 plans for individual enrollment and an average of 24 D-SNPs.
Access to Medicare Advantage Plans, by Plan Type
As in recent years, virtually all Medicare beneficiaries (99.7%) have access to a Medicare Advantage plan as an alternative to traditional Medicare, including almost all beneficiaries in metropolitan areas (99.99%) and the vast majority of beneficiaries in non-metropolitan areas (98.4%). In non-metropolitan counties, a smaller share of beneficiaries have access to HMOs (91% in non-metropolitan versus 99% in metropolitan counties) or local PPOs (93% in non-metropolitan versus 98% in metropolitan counties), and a slightly larger share of beneficiaries have access to regional PPOs (77% in non-metropolitan counties versus 72% in metropolitan counties).
Number of Firms
The average Medicare beneficiary is able to choose from plans offered by 9 firms in 2022, one more than in 2021 (Figure 6). Despite most beneficiaries having access to plans operated by several different firms, enrollment is concentrated in plans operated by UnitedHealthcare, Humana, and Blue Cross Blue Shield affiliates. Together, UnitedHealthcare and Humana account for 45 percent of MA enrollment in 2021.
More than one-third of beneficiaries (35%) are able to choose from plans offered by 10 or more firms or other sponsors. Sixteen firms are offering Medicare Advantage plans in five counties: Maricopa and Pima counties in Arizona, Fort Bend and Montgomery counties in Texas, and Miami-Dade, Florida. In contrast, in 87 counties, most of which are rural counties with relatively few Medicare beneficiaries (less than 1% of total), only one firm will offer Medicare Advantage plans in 2022. Over the past several years, the number of counties with a single firm offering Medicare Advantage plans has fallen substantially. As recently as 2019, there was a single firm offering plans in nearly 200 counties.
Availability of Plans by Firm and County. UnitedHealthcare and Humana, the two firms with the most Medicare Advantage enrollees in 2021, have large footprints across the country, offering plans in most counties. Humana is offering plans in 85 percent of counties and UnitedHealthcare is offering plans in 74 percent of counties in 2022 (Figure 7). About 9 in 10 (89%) Medicare beneficiaries have access to at least one Humana plan and 90 percent have access to at least one UnitedHealthcare plan.
Most major Medicare Advantage firms have also expanded the number of counties where they are offering plans. Humana is offering plans in 2,737 counties in 2022, an increase of 29 from 2021, while UnitedHealthcare is offering plans in 2,377 counties in 2022, an increase of 259 from 2021. Blue Cross Blue Shield Affiliates are offering plans in 2,190 counties in 2022, an increase of 285 plans from 2021. CVS Health is offering plans in 1,840 counties, an increase of 81 counties since 2021; Centene is offering plans in 1,525 counties, an increase of 396 counties; and Cigna is offering plans in 477 counties, an increase of 108 counties. Kaiser Permanente had the smallest growth and is offering plans in 116 counties, an increase of 7 counties.
Multiple Plan Offerings by Firms in the Same County. Many Medicare Advantage firms are also offering more than one plan option in each county. In 585 counties (accounting for 34% of beneficiaries), at least one firm is offering 10 or more plans. In 82 of those counties, two firms are offering 10 or more plans, and in 12 counties, three firms are offering 10 or more plans. Blue Cross Blue Shield Affiliates are offering the most plan options in a county, with 18 different plan options in six counties. Humana is offering the next highest number of plan choices with 14 in five counties, followed by Centene and CVS, which are offering 13 plan options in four counties and two counties, respectively. United Healthcare is offering 10 plan options in two counties.
New Market Entrants and Exits
Medicare Advantage continues to be an attractive market for insurers, with 20 firms entering the market for the first time in 2022, collectively accounting for about 19 percent of the growth in the number of plans available for general enrollment and about 6 percent of the growth in SNPs (Appendix Table 2). Thirteen new entrants are offering HMOs available for individual enrollment. Nine of the new entrants are offering SNPs; seven firms are offering D-SNPs for people dually eligible for Medicaid, one firm is offering a C-SNP for people with select chronic conditions, and one firm is offering an I-SNP.
Three of the new firm entrants are offering plans in Massachusetts, two are offering plans in California, Florida, North Carolina, South Carolina, and Utah, and the remainder are offering plans in at least one of thirteen other states (Arizona, Indiana, Louisiana, Maryland, Michigan, Minnesota, Montana, New Hampshire, North Dakota, South Dakota, Oklahoma, Rhode Island, and Texas).
Seven firms that previously participated in the Medicare Advantage market are not offering plans in 2022. Six of the firms had very low enrollment in 2021, while one firm (Sunrise Advantage Plan) had no enrollment in 2021. Two of the seven exiting firms offered plans in California.
The vast majority of Medicare Advantage plans for individual enrollment (89%) will include prescription drug coverage (MA-PDs), and 59 percent of these plans will charge no premium, other than the Part B premium, somewhat higher than 2021 (54 percent). More than nine out of ten beneficiaries (98%) have access to a MA-PD with no monthly premium in 2022. However, in Alaska and Wyoming, beneficiaries do not have access to a zero-premium MA-PD.
In 2021, 65 percent of enrollees in MA-PD plans pay no premium other than the Medicare Part B premium of $148.50 per month. Based on enrollment in March 2021, 15% of enrollees pay at least $50 a month, including 5 percent who pay $100 or more. CMS announced that the average monthly plan premium among all Medicare Advantage enrollees in 2022, including those who pay no premium for their Medicare Advantage plan, is expected to decrease from 2021 to $19 a month.
Medicare Advantage plans may provide extra benefits that are not available in traditional Medicare, are considered “primarily health related,” and can use rebate dollars (including bonus payments) to help cover the cost of these extra benefits. Beginning in 2019, CMS expanded the definition of “primarily health related” to allow Medicare Advantage plans to offer additional supplemental benefits. Medicare Advantage plans may also restrict the availability of these extra benefits to certain subgroups of beneficiaries, such as those with diabetes or congestive heart failure, making different benefits available to different enrollees.
Availability of Extra Benefits in Plans for General Enrollment. Historically, the extra benefits offered most often were fitness, dental, vision, and hearing. More than 90% of individual plans offer access to vision, fitness, telehealth, hearing or dental benefits in 2022. Though these benefits are widely available, the scope of specific services varies. For example, a dental benefit may include cleanings only or more comprehensive coverage, often subject to an annual cap on the amount covered by the plan. (Figure 8).
As of 2020, Medicare Advantage plans have been allowed to include telehealth benefits as part of the basic benefit package – beyond what was allowed under traditional Medicare prior to the COVID-19 public health emergency. These benefits are shown in the figure above, even though their cost are built into the bid, and are not covered by either rebates or supplemental premiums. Additionally, Medicare Advantage plans may offer supplemental telehealth benefits via remote access technologies and/or telemonitoring services, which can be used for those services that do not meet the requirements for coverage under traditional Medicare or the requirements for the telehealth benefits as part of the basic benefit package (such as the requirement of being covered by Medicare Part B when provided in-person). The vast majority (95%) of Medicare Advantage plans are offering telehealth in 2022.
Other extra benefits that are frequently offered for 2022 include over the counter items, such as adhesive or elastic bandages (81%), meal benefits, such as a cooking class, nutrition education, or meal delivery (67%), and transportation benefits (38%). Less than 10 percent of plans provide bathroom safety devices (8%) or telemonitoring services (3%), and support for caregivers of enrollees (3%). This is not an exhaustive list of extra benefits that plans offer, and plans may provide other services such as home-based palliative care, therapeutic massage, and adult day health services, among others.
Access to Extra Benefits. Virtually all Medicare beneficiaries live in a county where at least one Medicare Advantage plan available for general enrollment has some extra benefits not covered by traditional Medicare, with 99% having access to some dental, fitness, vision, and hearing benefits for 2022. The vast majority of beneficiaries also have access to telehealth benefits (99%), over the counter items (99%), a meal benefit (99%), transportation assistance (97%) and but fewer have access to in-home support services (76%) or bathroom safety devices (63%).
Availability of Extra Benefits in Special Needs Plans. SNPs are designed to serve a disproportionately high-need population, and a somewhat larger percentage of SNPs than plans for other Medicare beneficiaries provide their enrollees with over the counter items (93%), transportation benefits (87%) and in-home support services (25%). Similar to plans available for general enrollment, a relatively small share of SNPs provide bathroom safety devices (12%) or telemonitoring services (5%).
Availability of Special Supplemental Benefits for the Chronically Ill (SSBCI). Beginning in 2020, Medicare Advantage plans have also been able to offer extra benefits that are not primarily health related for chronically ill beneficiaries, known as Special Supplemental Benefits for the Chronically Ill (SSBCI). Information on the availability of SSBCI for 2022 has not yet been published by CMS, but we include data on the availability of benefits in 2021.
The vast majority of plans do not yet offer these benefits, but a larger share of SNP plans tend to offer SSBCI benefits than plans for individual enrollment. Some of the most frequently offered SSBCI benefits include food and produce (6.6% for individual plans and 20.5% for SNPs), meals (beyond a limited basis) (6.0% in individual plans and 12.3% for SNPs), and pest control (5.1% for individual plans and 14.6% for SNPs) (Figure 9).
More Medicare Advantage plans are being offered for 2022 than in any other year. Twenty insurers are entering the Medicare Advantage market for the first time, and seven insurers are exiting the market, suggesting that Medicare Advantage remains an attractive, profitable market for insurers. Overall, more than 99 percent of beneficiaries will have access to one or more Medicare Advantage plans in 2022, similar to prior years. With more firms offering SNPs and the number of SNPs rapidly growing, there may be greater focus on how well high-need, vulnerable beneficiaries are being served by Medicare Advantage plans, including SNPs as well as plans for general enrollment. As Medicare Advantage enrollment continues to grow, insurers seem to be responding by offering more plans and choices to the people on Medicare.
Anthony Damico is an independent consultant.
|This analysis focuses on the Medicare Advantage marketplace in 2022 and trends over time. The analysis includes more than 26 million enrollees in Medicare Advantage plans in 2021.
Data on Medicare Advantage plan availability, enrollment, and premiums were collected from a set of data files released by the Centers for Medicare & Medicaid Services (CMS):
KFF’s plan counts may be lower than those reported by CMS and others because KFF uses overall plan counts and not plan segments. Segments generally permit a Medicare Advantage organization to offer the “same” local plan, but may vary supplemental benefits, premium and cost sharing in different service areas (generally non-overlapping counties).