Immigration has been a hot-button issue in U.S. political debate for decades, with policymakers trying to balance economic, security, and humanitarian concerns, and candidates on both sides using immigration talking points to appeal to their base. Immigration policy at the federal level has often shifted dramatically between presidential administrations, and enforcement differs between states. However, debates over immigration policies, including those that restrict or promote pathways to citizenship and access to benefits for undocumented immigrants, often leave out the viewpoints of immigrants themselves, and in some cases, immigrant feel they are treated as pawns in a political game.

A majority of immigrants are naturalized citizens (58%) and thus eligible to vote in U.S. elections, but their views are not often explored in polls of the general public. Immigrants who are noncitizens may have other ways to influence the U.S. political process, but many face language barriers and immigration-related fears that make it difficult for them to engage in the political process.

The Survey of Immigrants, a partnership between KFF and The Los Angeles Times, is the largest nationally representative survey focused on immigrants, interviewing 3,358 immigrant adults in 10 languages. This report focuses on the political engagement, attitudes, and policy preferences of the growing immigrant population in the U.S.

Highlights

• Most immigrants (62%) say they pay attention to politics and government in the U.S. a least a “fair amount,” though few (17%) say they pay “a lot” of attention. Older immigrants, naturalized citizens and those who are English proficient are among the most likely groups of immigrants to say they pay a lot of attention to U.S. affairs.
• Immigrants, including naturalized citizens, lean more towards the Democrats when asked which political party represents their own views, which party best represents the interests of immigrants overall, and whether immigrants were better off under the Biden or Trump presidencies.
• However, many immigrants do not feel that their views or the interests of immigrants generally are well represented by either of the two major U.S. political parties, and half of all immigrants say that who the president is makes no difference in the lives of immigrants.
• Like most U.S.-born adults, a large majority (79%) of immigrant adults support allowing undocumented immigrants who were brought to the U.S. as children to apply for citizenship. A smaller majority of immigrants (59%) also supports allowing undocumented immigrants to sign up for government-sponsored health insurance, though immigrants who are naturalized citizens are split on this question and a majority (69%) of U.S.-born adults are opposed.

Attention to Politics and Political Leanings of Immigrants

Most immigrants report paying at least some attention to U.S. politics, with those who are older, English proficient, and naturalized citizens being the most engaged. About six in ten (62%) immigrants say they follow politics and government in the U.S. a lot (17%) or a fair amount (45%), with majorities across age and immigration statuses saying they follow it at least a fair amount. Immigrants ages 65 and older, naturalized citizens, and immigrants who speak English at least “very well” are most likely to report that they pay “a lot” of attention to politics and government in the U.S.

Twice as many immigrants say that immigrants in general are better off under a Biden presidency than a Trump presidency, but about half say who the president is makes no difference in the lives of immigrants. One in three (33%) say immigrants are better off under Biden, and one in six (16%) say immigrants were better off under Trump.

Immigrants who say they follow U.S. politics “a lot” or “a fair amount” are more likely than those who do not to say who the president is makes a difference, yet across levels of political interest, immigrants lean towards President Biden when asked which recent president was better for immigrants. While, unsurprisingly, six in ten immigrants who say they are best represented by the Democratic Party say immigrants are better off under Biden and about half (53%) of Republican-identifying immigrants say immigrants are better off under Trump, one-third of immigrants who say they are best represented by either the Democrats (34%) or Republicans (32%) say it “makes no difference” who the president is.

Larger shares of immigrants say that the Democratic Party represents their own personal political views better than the Republican Party. Immigrants overall are twice as likely to say that the Democratic Party (32%) represents their political views better than the Republican Party (16%). However, this still leaves about half of immigrants saying that neither party (25%) best represents their views or that they are not sure (27%). Majorities of undocumented immigrants (76%), recent immigrants (67%), immigrants who do not pay attention to U.S. politics (65%), and younger immigrants (ages of 18 and 29) (65%) say they are “not sure” or that neither party represents their political views.

Immigrants differ by race and ethnicity on their partisan leanings, with Hispanic, Asian, and Black immigrants leaning towards the Democratic Party and White immigrants more evenly split between saying the Democratic and Republican parties best represent their views. Across racial and ethnic groups, large shares—between four in ten and six in ten—say neither party best represents them or that they are not sure.

Although more Hispanic immigrants say they feel better represented by the Democratic Party, there are some differences by country or region of origin. Immigrants from South America (18%), Central America (15%), and the Caribbean (18%) are about twice as likely as those from Mexico (7%) to say the Republican Party best represents their political views. Roughly equal shares—three in ten—across these countries and regions say they feel represented by the Democrats, though larger shares of immigrants from Central America (41%) and Mexico (38%) say they are “not sure” which party better represents their views compared to those from South America (26%) or the Caribbean (23%). Among immigrants from Asia, there are few differences by country or region of origin.

Immigrants in California are more likely to say the Democratic party represents their views (36%) while a smaller share in Texas says the same (25%). Yet in both states, about three in ten immigrants say they are not sure and about one in four say neither party better represents their political views.

Nearly half of immigrants (46%) say they think the Democratic Party represents the interests of immigrants at least “somewhat well,” more than twice the share who say the same about the Republican Party (20%). Immigrants across immigration statuses are more likely to say the Democratic Party represents immigrants’ interests well than the Republican Party. Three in ten say they are “not sure” about how well the Republican (33%), or Democratic (31%) Parties represent the interests of immigrants. Noncitizens are more likely to say they are “not sure” how well each of the political parties represent the interests of immigrants.

Attitudes Towards Immigration Policies

Immigrants have mixed views in their assessments of whether U.S. enforcement of immigration laws is too tough or not tough enough, which stands in stark contrast to the views of U.S.-born adults.¹  About one in five immigrant adults say the U.S. is “too tough” (19%) and a similar share say the U.S. is “not tough enough” (18%) in enforcing immigration laws, while about one-fourth (27%) say enforcement is “about right,” and about one-third (35%) say they are not sure. U.S.-born adults are much more likely to say that enforcement of these laws is “not tough enough” (52%), while one in six say enforcement is “too tough” (15%) or “about right” (14%). Immigrants vary somewhat in their assessments of immigration enforcement by immigration status, as naturalized citizens are somewhat more likely to say the U.S. is not tough enough in enforcement, while those who are likely undocumented are more likely to say they are “not sure.”

Immigrants’ views on U.S. enforcement of immigration laws are also largely divided by their political leanings. Immigrants who say their views are best represented by the Democratic Party (referred to here as Democratic-leaning) are more likely than Republican-leaning immigrants or immigrants who do not feel represented by either political party to say that enforcement in the U.S. is “too tough” (29%). Republican-leaning immigrants are most likely to say that enforcement in the U.S. is “not tough enough” (48%). However, many immigrants are not sure if immigration enforcement in the U.S. is too tough or not, including about one in four Democratic-leaning (26%) immigrants, one in five Republican-leaning (22%) immigrants and 45% of immigrants who do not have a political leaning.

The idea of allowing undocumented immigrants who were brought to the U.S. as children to apply for citizenship is widely popular, with about eight in ten immigrants (79%) and two-thirds of U.S.-born adults saying this is a “good idea.” This proposal has been introduced to Congress in a variety of forms over the past two decades as The Development, Relief, and Education for Alien Minors Act, or DREAM Act, but has failed to pass. Immigrants across partisan affiliation and citizenship status largely support the policy, though fewer (55%) Republican-leaning immigrants say this is a good idea. Under the Deferred Action for Childhood Arrivals (DACA) program created in 2012, eligible young adults who were brought to the U.S. as children can receive protection from deportation and work authorization for temporary, renewable periods. However, DACA does not provide a pathway to U.S. citizenship, and the federal government is not currently processing new DACA requests due to court orders.

While a majority of immigrants support allowing undocumented immigrants to sign up for government-sponsored health insurance, a majority of U.S.-born adults say this is a “bad idea.” Nearly twice the share (59%) of immigrants than U.S.-born adults (30%) say this policy is a “good idea.” Even still, immigrants are split by immigration status and partisan affiliation on their support for this policy. Immigrants who are likely undocumented or lawfully present are more likely to say this policy is a “good idea” (85% and 68%) while naturalized citizens are split, with half saying it is a “good idea” (49%) and half saying it is a “bad idea” (48%). Similar shares of Democratic-leaning immigrants say the policy is a good idea (71%) and Republican-leaning immigrants say it is a bad idea (71%).

Notably, these questions did not offer arguments for or against the policies, and support may be higher or lower in a more contextualized situation.

The KFF/LA Times Survey of Immigrants is a partnership survey conducted by KFF and the LA Times examining the U.S. immigrant experience.

The survey was conducted April 10-June 12, 2023, online, by telephone, and by mail among a nationally representative sample of 3,358 immigrants, defined as adults living in the U.S. who were born outside the U.S. and its territories. Respondents had the option to complete the survey in one of ten languages: English (n=2,435), Spanish (n=627), Chinese (n=171), Korean (n=52), Vietnamese (n=22), Portuguese (n=16), Haitian-Creole (n=13), Arabic (n=9), French (n=9), and Tagalog (n=4). These languages were chosen as they are most commonly spoken by immigrant adults from countries of focus for the survey with limited English proficiency (LEP), based on the 2021 American Community Survey (2021).

Teams from KFF and The Los Angeles Times worked together to develop the questionnaire and both organizations contributed financing for the survey. KFF researchers analyzed the data, and each organization bears the sole responsibility for the work that appears under its name. Sampling, data collection, weighting, and tabulation were managed by SSRS of Glenn Mills, Pennsylvania in collaboration with public opinion researchers at KFF.

Respondents were reached through one of three sampling modes: an address-based sample (ABS) (n=2,661); a random digit dial telephone (RDD) sample of prepaid (pay-as-you go) cell phone numbers (n=565); and callbacks to telephone numbers that that were previously randomly sampled for RDD surveys and were identified as speaking a language other than English or Spanish (n=132). Respondents from all three samples were asked to specify their country of birth and qualified for the survey if they were born outside of the U.S.

Project design was informed by a pilot study conducted from January 31-March 14, 2022 among a sample of 1,089 immigrants in collaboration with SSRS. Prior to fielding the pilot study, KFF and SSRS conducted interviews with experts who had previous experience surveying immigrants. These conversations informed decisions on sampling, modes of data collection, recruitment strategies, and languages of interviews. The pilot test measured incidence of immigrant households across four different sample types and offered a short survey in 8 different languages both online and on the telephone. Based on the results of the pilot test, the following recruitment and data collection protocol was implemented:

Sampling strategy and interview modes:

The ABS was divided into areas (strata), defined by Census tract, based on the incidence of immigrants among the population overall and by countries of origin. Within each stratum, the sample was further divided into addresses that were flagged by Marketing Systems Group (MSG) as possibly occupied by foreign-born adults and unflagged addresses. To increase the likelihood of reaching immigrant adults, strata with higher incidence of immigrant households overall, and of immigrants from certain countries of origin were oversampled.

Households in the ABS were invited to participate through multiple mail invitations: 1) an initial letter in English with a short paragraph of instructions in each of the 10 survey languages on the back; 2) a reminder postcard in English plus up to two additional languages; 3) a follow-up letter accompanied by hardcopy questionnaires in English and one additional language; and 4) a final reminder including short messages in all 10 languages. For mailings 2 and 3, additional languages were chosen by using flags to identify the language other than English likely spoken at home. Invitation letters requested the household member ages 18 or older who was born outside of the U.S. with the most recent birthday to complete the survey in one of three ways: by going online, dialing into a toll-free number, or returning the completed paper questionnaire. In addition, interviewers attempted outbound calls to telephone numbers that were matched to sampled addresses. ABS respondents completed the survey online (n=2,087), over the phone (n=105), or by mail on paper (n=469). The random sample of addresses was provided by MSG.

The RDD sample of prepaid (pay-as-you-go) cell phone numbers was obtained through MSG. The prepaid cell phone component was disproportionately stratified to effectively reach immigrants from different countries based on county-level information. To increase the likelihood of reaching immigrant adults, counties with higher incidence of immigrants overall, and of certain countries of origin were oversampled.

The callback sample included 132 respondents who were reached by calling back telephone numbers that were previously randomly sampled for SSRS RDD surveys within two years and coded by interviewers as non-English or non-Spanish speaking.

Incentives:

Initial mailings to the ABS sample included $2 as part of the invitation package, and respondents received a $10 incentive if they completed the survey in the first two weeks after the initial mailing. In order to increase participation among under-represented groups, the incentive increased to $20 for those who did not respond within the first two weeks. ABS phone respondents received this incentive via a check received by mail, paper respondents received a Visa gift card by mail, and web respondents received an electronic gift card incentive. Respondents in both phone samples received a $25 incentive via a check received by mail.

Questionnaire design and translation:

In addition to collaboration between KFF and the LA Times, input from organizations and individuals that directly serve or have expertise in issues facing immigrant populations helped shaped the questionnaire. These community representatives were offered a modest honorarium for their time and effort to review questionnaire drafts, provide input, attend meetings, and offer their expertise on dissemination of findings.

After the content of the questionnaire was largely finalized, SSRS conducted a telephone pretest in English and adjustments were made to the questionnaire. Following the English pretest, Research Support Services Inc. (RSS) translated the survey instrument from English into the nine languages outlined above and performed cognitive testing through qualitative interviews in all languages including English. The results of the cognitive testing were used to adjust questionnaire wording in all languages including English to ensure comprehension and cohesiveness across languages and modes of interview. As a final check on translation and its overlay into the web and CATI program, translators from Cetra Language Solution reviewed each question, as it appears in the program, and provided feedback. The questionnaire was revised and finalized based on this feedback.

Data quality checks:

A series of data quality checks were run on the final data. The online questionnaire included two questions designed to establish that respondents were paying attention and cases were monitored for data quality. Fifteen cases were removed from the data because they failed two or more quality checks, failed both attention check questions, or skipped over 50% of survey questions. An additional 67 interviews were removed after deemed ineligible by SSRS researchers (they were not U.S. immigrants).

Weighting:

The combined sample was weighted to adjust for the sampling design and to match the characteristics of the U.S. adult immigrant population, based on data from the Census Bureau’s 2021 American Community Survey (ACS). Weighting was done separately for each of 11 groups defined by country or region of origin (Mexico, China, Other East/Southeast Asia, South Asia, Europe, Central America, South America, Caribbean, Middle East/North Africa, Sub-Sahara Africa, all others). The samples were weighted by sex, age, education, race/ethnicity, census region, number of adults in the household, presence of children in the household, home ownership, time living in the U.S., English proficiency, and U.S. citizenship. The overall sample was also weighted to match the share of U.S. adult immigrants from each country/region of origin group. The weights take into account differences in the probability of selection for each of the three sample types. This includes adjustment for the sample design and geographic stratification, and within household probability of selection. Subgroup analysis includes data checks to ensure that the weighted demographics of subgroups are within reasonable range from benchmarks whenever possible.

The margin of sampling error including the design effect for the full sample is plus or minus 2 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available by request. Sampling error is only one of many potential sources of error and there may be other unmeasured error in this or any other public opinion poll. KFF public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research.

Focus group methodology:

As part of this project, KFF conducted 13 focus groups with immigrant adults across the country to help inform survey questionnaire development, provide deeper insights into the experiences of immigrant groups that had a smaller sample size in the survey, and to provide a richer understanding of some of the survey findings.

Two rounds of focus groups were completed. The first round of 6 groups was conducted between September-October 2022 virtually among participants living across the country who are Hispanic immigrants (conducted in Spanish), Asian (excluding Chinese) immigrants (conducted in English), or Chinese immigrants (conducted in Mandarin Chinese). The groups were separated by gender, lasted 90 minutes, and included 5-7 participants each.

The second round of groups were conducted in-person between May-June 2023 in Los Angeles, CA and Fresno, CA with Hispanic immigrants conducted in Spanish; and in Houston, TX and Irvine, CA with Vietnamese immigrants conducted in Vietnamese. In addition, virtual groups were conducted among participants living in the Texas border region (Hispanic immigrants), the Miami, FL region (Haitian immigrants), and nationally (Black immigrants from sub-Saharan Africa). Groups were mixed gender, lasted between 90 minutes and two hours, and were conducted in English, Spanish, Vietnamese, and Haitian-Creole with 5-8 participants each.

For each group, participants were chosen based on the following criteria: Must be at least 18 years of age and have been born outside of the U.S. and its territories; for groups conducted in languages other than English, must speak English “less than very well” and be able to speak conversationally in the group’s language (i.e., Spanish). In addition, groups were chosen to represent a mix of household composition, including at least some participants who are parents; a mix of household income levels, with a preference for recruiting lower income participants; a mix of health insurance types; and a mix of immigration statuses. Goodwin Simon Strategic Research (GSSR) recruited and hosted the first round of focus groups. PerryUndem recruited and hosted the second round of focus groups. The screener questionnaire and discussion guides were developed by researchers at KFF in consultation with the firms who recruited and hosted the groups. Groups were audio and video recorded with participants’ permission. Each participant was given $150-$175 after participating.

1. u00a0u00a0Supplemental to the Survey of Immigrants, KFF also conducted a representative survey of 1,049 U.S.-born adults. to compare the immigrant and native-born experience. KFF/LA Times Survey of Immigrants: U.S. Born Adult Comparison (June 29 u2013 July 9, 2023). ↩︎

Key Takeaways

The latest KFF COVID-19 Vaccine Monitor survey suggests the lack of public concern about getting sick from COVID-19 may be why many people have not gotten the latest vaccine and why half of the public are not planning on taking precautions to limit the spread of the virus during the coming months.

• As the public heads into the fourth holiday season with the virus, about half of adults say they do not plan to get the latest vaccine which became publicly available nearly two months ago. This includes three in ten of those who were previously vaccinated. A quarter of the public say that while they have not gotten the latest vaccine, they intend to do so.
• That leaves about two in ten adults reporting having gotten the latest COVID-19 vaccine. Consistent with demographic differences across other COVID-related behaviors, uptake of the new vaccine is highest among those ages 65 and older (34%) and Democrats (32%). Smaller shares of younger adults ages 18-29 (18%), Republicans (11%) and independents (16%) report getting the latest vaccine. Similar shares across racial and ethnic groups say they have gotten the updated vaccine, including 26% of Black adults, 20% of Hispanic adults, and 19% of White adults. However, when combining the shares who have gotten the shot and those who intend to get it, Black adults (59%) and Hispanic adults (59%) both outpace White adults (42%).
• The latest COVID-19 Vaccine Monitor survey explores why previously vaccinated people haven’t received the latest vaccine and finds decreasing concerns around the virus tops the list of reasons. About half (52%) of those who were previously vaccinated but haven’t gotten the latest shot say lack of worry about COVID-19 is a reason why they haven’t gotten the vaccine. Getting vaccinated is also seemingly not the priority it once was, with many also saying they haven’t gotten it because they have been too busy (37%) or that they are waiting to get it a later date (32%).
• With the upcoming winter holidays, small shares of the public are worried COVID-19 will impact their holiday plans. About three in ten are worried they will spread COVID-19 to people close to them (31%) or that they will get seriously sick from COVID-19 (28%), and about a quarter (26%) worry they will get COVID-19 over the holidays. A larger share of the public is worried about increased hospitalizations, with almost half (46%) saying they are “very” or “somewhat worried” that there will be an increase in hospitalizations in the U.S. this winter.
• The public is divided on precautions this upcoming season, with half of adults saying they are planning to take at least one of several precautions to limit the spread of COVID this fall and winter, while the other half are not planning to take any of the precautions asked about in the survey. The most common precautions people say they plan to take are avoiding large gatherings (35%) or wearing a mask in crowded places (30%). Smaller shares say they are avoiding travel this fall and winter (25%), avoiding dining indoors at restaurants (19%), or taking a COVID-19 test before visiting with friends or family (18%). Some groups are more likely to report taking such precautions including majorities of Black adults (72%), Hispanic adults (68%), Democrats (66%), and just over half (53%) of vaccinated adults. 

The Latest COVID-19 Vaccine Uptake And Intentions

The November KFF COVID-19 Vaccine Monitor investigates uptake for the new, updated COVID-19 vaccine, which has been recommended by the CDC for people ages 6 months and older. Two months after the vaccine became available, about half of adults say they have gotten or will get the shot, but another half say they won’t get the latest shot and a third seem steadfast in that decision.

One in five (20%) adults now say they have received the new, updated COVID-19 vaccine that became available in September. An additional one in four adults say they will “definitely get” (13%) or “probably get” (15%) the updated shot. Consistent with demographic differences across other COVID-related behaviors, uptake is highest among those ages 65 and older (34%) and Democrats (32%). This is meaningful given that those ages 65 and older are more vulnerable to COVID-19, as they’re more likely to get seriously sick and experience complications that could result in hospitalization. This is in comparison to smaller shares of younger adults ages 18-29 (18%), Republicans (12%) and independents (16%) who report getting the latest vaccine. Similar shares across racial and ethnic groups report having gotten the updated vaccine, including 26% of Black adults, 20% of Hispanic adults, and 19% of White adults. However, when combining the shares who have gotten the shot and those who intend to get it, Black adults (59%) and Hispanic adults (59%) both outpace White adults (42%).

Uptake of the newest vaccine matches closely to uptake of the updated bivalent booster measured in December 2022, just after the updated bivalent COVID-19 booster had become available for use. About two in ten adults said they had received the booster dose (22%).

One in three (34%) adults say they will “definitely not” get the new COVID-19 vaccine, and another 17% say they will “probably not” get the vaccine. The share who say they “probably” or “definitely” won’t get the new COVID-19 vaccination has remained unchanged from the September COVID-19 Vaccine Monitor, which was fielded immediately prior to when the vaccine became available.

Majorities of those who have never received any COVID-19 vaccine (94%), Republicans (77%), independents (59%), those who live in rural areas (65%), White adults (58%), and those under the age of 65 (55%) continue to say they will not get the updated COVID-19 vaccine.

The survey finds that partisanship is continuing to play an outsized role in vaccine attitudes. While nearly six in ten White adults say they do not plan to get the new vaccine, this increases to eight in ten among White adults who self-identify as Republicans. This is more than twice the share of White adults who are Democrats (29%) who say they will either “definitely not” or “probably not” get the vaccine. In fact, three in ten (31%) White adults who are Democrats have already gotten the new vaccine, compared to 11% of their Republican counterparts.

Most adults (79%) say they have heard at least “a little” about the updated COVID-19 vaccine, with one in five (22%) saying they have heard “a lot.” A small share (21%) say they have heard “nothing at all” about the updated vaccine.

Awareness is high across demographic groups, including the vast majority (92%) of adults ages 65 and older who have heard at least “a little” about the updated vaccine compared to a somewhat smaller share, but still a majority, of younger adults, including six in ten of those ages 18 to 29. Larger shares of Democrats are also more aware of the vaccine, with 86% who have heard at least “a little” compared to three-quarters (74%) of Republicans.

With most people aware of the latest vaccine, many, including large shares of previously vaccinated adults, have not yet received the updated shot and some don’t plan to. About six in ten (58%) adults are previously vaccinated and have yet to get the updated vaccine. This group is roughly divided between people who say they will get the vaccine and those who say they are not planning to get the latest shot. The latest COVID-19 Vaccine Monitor survey explores why this group of previously vaccinated people have not gotten the latest dose.

Around half of adults (47%) have both previously received a COVID-19 vaccine and also say they will get or have already gotten the updated vaccine. On the other hand, one in five (20%) adults are previously unvaccinated and say they will not get the updated vaccine. That leaves three in ten (31%) who have previously been vaccinated but now say they will not get the updated shot.

More than four in ten Republicans (43%) and one in three independents (35%) say they are previously vaccinated but won’t get the updated shot, compared to 19% of Democrats. A larger share of White adults (34%) also report being previously vaccinated but not planning on getting the latest shot compared to Black adults (20%). Around a quarter of Hispanic adults (26%) are previously vaccinated but now do not plan to get the latest vaccine.

Decreasing Concerns About COVID top The Reasons for Not Getting the Latest Vaccine

In 2021, KFF surveys examining initial vaccine rollout found that concerns about vaccine safety were the driving reason why people didn’t get vaccine. Even as those concerns dissipated among most of the public, a small share of the public remained steadfast and never received a COVID-19 vaccine. Yet, subsequent booster never reached the same uptake levels as seen in the initial vaccine rollout. And as the country enters its fourth year of COVID-19 concerns, it appears this trend continues.

When asked about a series of reasons that could explain why people are not getting the latest vaccine, not being worried about getting COVID-19 tops the list. About half (52%) of those who were previously vaccinated say lack of worry about COVID-19 is at least a minor reason why they haven’t gotten the vaccine, including a quarter who say it is a “major reason.” Getting vaccinated may also not be a priority for some with around four in ten (37%) saying being too busy is at least a minor reason why they have not gotten it yet, and another third saying they are waiting to get it a later date. Experiences from previous doses may also be keeping people from getting the new vaccine with about a quarter saying that bad side effects from a previous COVID-19 vaccine dose is a reason why they have not gotten the new vaccine.

Small shares say there are other barriers to getting the vaccine including 16% who say they cannot take the time off work and 13% who say they haven’t been able to get an appointment. One in ten (11%) say their doctor told them to wait or to not to get the updated vaccine.

Among Hispanic adults who were previously vaccinated but have not gotten the new shot, about half (55%) say they aren’t worried about getting COVID-19, they are too busy (51%), or they are waiting to get it at a later date (48%). In addition, a third (35%) of Hispanic adults as well as a quarter (22%) of Black adults cite not being able to take time off work, compared to just one in ten (9%) White adults.

Democrats’ top reasons for not getting the updated COVID-19 vaccine suggests there will likely still be additional uptake in this group, while Republicans’ top reasons may indicate more resistance to the latest vaccine. Among those who were previously vaccinated but haven’t gotten the new shot, half of Democrats (49%) say being too busy is a “major” or “minor” reason they haven’t gotten the updated vaccine yet, compared to 22% of Republicans and 35% of independents. On the other hand, two-thirds of Republicans (66%) and more than half of independents (57%) say not being worried about getting COVID is at least a minor reason why they have not gotten the updated vaccine, compared to a third of Democrats (35%).

Half Of The Public Says COVID-19 Isn’t Changing Their Holiday Plans

With fall and winter holidays coming up, the possibility of a further wave of COVID-19 infections is looming with increased indoor gatherings and time with friends and family. Yet, most of the public is not worried about spreading or catching COVID-19 over the coming months. About three in ten adults are worried they will spread COVID-19 to people close to them (31%) or they will get seriously sick from COVID-19 (28%), and about a quarter (26%) are worried they will get COVID-19 over the holidays. A larger share of the public is worried about increased hospitalizations, with almost half (46%) saying they are “very” or “somewhat worried” that there will be an increase in hospitalizations in the U.S. this winter.

Older adults are not more worried than younger adults about the spread of COVID-19 this holiday season except for concerns about increases in cases and hospitalizations. Around half (53%) of adults ages 65 and older say they are worried that there will be an increase in COVID-19 cases and hospitalizations this winter, compared to smaller shares (44%) of those under the age of 65.

Around the same share say they are “very” or “somewhat worried” about an increase in COVID-19 cases and hospitalizations this winter as were in December of last year when there was a similar uptick in COVID-19 cases.

Precautions Against COVID-19

In addition to not being worried about COVID-19 during the upcoming holidays, the public is divided on precautions, with half of adults saying they aren’t planning to take any of the precautions asked about in the survey, while the other half report they plan to take at least one precaution this fall and winter. The most common precautions people said they planned to take were avoiding large gatherings (35%) or wearing a mask in crowded places (30%). Smaller shares say they are avoiding travel this fall and winter as a precaution against COVID-19 (25%), avoiding dining indoors at restaurants (19%), or taking a COVID-19 test before visiting with friends or family (18%).

The share who say they plan to take precautions to limit the spread of COVID is similar to the share of the public who said they were taking precautions because of the “tripledemic” back in January of this year. Back then, about half (46%) of adults said the news of COVID-19, RSV, and the flu spreading that winter had made them more likely to take a precaution, including three in ten (31%) who said they were more likely to wear a mask in public and a quarter (26%) who were more likely to avoid large gatherings.

While four in ten (39%) White adults say they will take at least one precaution, majorities of Black adults (72%) and Hispanic adults (68%) report they are planning to take any of the precautions mentioned.

Similarly, partisanship and previous vaccine uptake continue to be strong predictors of whether people plan to take precautions to limit the spread of the virus. Two thirds (66%) of Democrats and half (48%) of independents say they plan to take at least one precaution, compared to three in ten (29%) Republicans who say the same. Just over half (53%) of vaccinated adults say they are taking any of the precautions, compared to four in ten (39%) unvaccinated adults.

Similar shares of younger and older adults report that they will be taking at least one precaution during the fall and winter. However, four in ten (41%) adults ages 65 and older say they plan to avoid large gatherings, compared to a third (33%) of those under the age of 65. While younger adults are less likely to say they will avoid large gatherings, larger shares of younger adults say they will take a test for COVID-19 before spending time with friends of family, with 21% who say so (including 25% of those ages 18-29), compared to one in ten (10%) of those ages 65 and older.

This KFF Health Tracking Poll/COVID-19 Vaccine Monitor was designed and analyzed by public opinion researchers at KFF. The survey was conducted October 31- November 7, 2023, online and by telephone among a nationally representative sample of 1,301 U.S. adults in English (1,222) and in Spanish (79). The sample includes 1,016 adults (n=52 in Spanish) reached through the SSRS Opinion Panel either online (n=991) or over the phone (n=25). The SSRS Opinion Panel is a nationally representative probability-based panel where panel members are recruited randomly in one of two ways: (a) Through invitations mailed to respondents randomly sampled from an Address-Based Sample (ABS) provided by Marketing Systems Groups (MSG) through the U.S. Postal Service’s Computerized Delivery Sequence (CDS); (b) from a dual-frame random digit dial (RDD) sample provided by MSG. For the online panel component, invitations were sent to panel members by email followed by up to three reminder emails.

Another 285 (n=27 in Spanish) interviews were conducted from a random digit dial telephone sample of prepaid cell phone numbers obtained through MSG. Phone numbers used for the prepaid cell phone component were randomly generated from a cell phone sampling frame with disproportionate stratification aimed at reaching Hispanic and non-Hispanic Black respondents. Stratification was based on incidence of the race/ethnicity groups within each frame.

Respondents in the phone samples received a $15 incentive via a check received by mail, and web respondents received a $5 electronic gift card incentive (some harder-to-reach groups received a $10 electronic gift card). In order to ensure data quality, cases were removed if they failed attention check questions in the online version of the questionnaire, or if they had over 30% item non-response, or had a length less than one quarter of the mean length by mode.  Based on this criterion, one case was removed.

The combined cell phone and panel samples were weighted to match the sample’s demographics to the national U.S. adult population based on parameters derived from the Census Bureau’s 2022 Current Population Survey (CPS), 2021 Volunteering and Civic Life Supplement data from the CPS, and the 2023 KFF Benchmarking survey with ABS and prepaid cell phone samples. The demographic variables included in weighting for the general population sample are sex, age, education, race/ethnicity, region, education, civic engagement, internet use, and political party identification by race/ethnicity.  The sample of registered voters was weighted separately to match the U.S. registered voter population using the parameters above plus recalled vote in the 2020 presidential election by county quintiles grouped by Trump vote share. Both weights take into account differences in the probability of selection for each sample type (prepaid cell phone and panel). This includes adjustment for the sample design and geographic stratification of the cell phone sample, within household probability of selection, and the design of the panel-recruitment procedure.

The margin of sampling error including the design effect for the full sample and registered voters is plus or minus 4 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available by request. Sampling error is only one of many potential sources of error and there may be other unmeasured error in this or any other public opinion poll. KFF public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research.

This analysis, originally published on Nov. 8, 2023, has been updated to reflect that CalOptima Health OneCare is not a new entrant in the Medicare Advantage market and that Orange County Health Authority and Imperial Health Plan of California are not exiting insurers. 

Over the last decade, Medicare Advantage, the private plan alternative to traditional Medicare, has taken on a prominent role in the Medicare program. In 2023, nearly 31 million Medicare beneficiaries are enrolled in a Medicare Advantage plan, more than half, or 51%, of the eligible Medicare population. This brief provides an overview of the Medicare Advantage plans that are available for 2024 and key trends over time. (A separate overview of the 2024 Medicare Part D marketplace is also available.)

Medicare Advantage Highlights for 2024

• The average Medicare beneficiary has access to 43 Medicare Advantage plans in 2024, the same as in 2023, but more than double the number of plans offered in 2018.
• HMOs account for more than half of all Medicare Advantage plans nationwide (56% in 2024) but are declining as a share of total, while local PPOs are rising as a share of all plans (42% in 2024).
• The number of D-SNPs (for dually-eligible beneficiaries) has increased substantially over the past five years, nearly doubling from 465 dual SNPs in 2019 to 851 dual SNPs in 2024.
• One-third of Medicare beneficiaries live in a county with more than 50 Medicare Advantage plans available in 2024, up from 1 percent in 2019. Less than 1 percent of beneficiaries live in a county with fewer than four Medicare Advantage plans available.
• The average Medicare beneficiary can choose among plans offered by 8 firms in 2024, one fewer than in 2023. Three new insurers entered the Medicare Advantage market in 2024, two of which offer SNPs, while twelve firms exited the market in 2024, principally due to low or no enrollment.
• Humana and UnitedHealthcare plans are available in most counties in 2024 (90% and 87%, respectively). Most major insurers are also expanding into new counties, with CVS Health expanding in the largest number of counties in 2024.
• Two thirds of all MA-PDs (66%) will charge no premium (other than the Part B premium) in 2024, the same as in 2023. In addition, 19% of Medicare Advantage plans will offer some reduction in the Part B premium in 2024, similar to 2023.
• Most Medicare Advantage plans are offering extra benefits, such as vision, dental and hearing as they have in previous years. Most Medicare Advantage plans are not offering Special Supplemental Benefits for the Chronically Ill, which are extra benefits available to a subset of a plan’s enrollees, that are not primarily health related, and are specifically for chronically ill beneficiaries. However, more SNP plans than individual plans generally offer these benefits, particularly food and produce (60.0% in SNPs compared to 13.9% in individual plans).

Plan Offerings in 2024

Number of Plans

Number of Plans Available to Beneficiaries. For 2024, the average Medicare beneficiary has access to 43 Medicare Advantage plans, the same as 2023, but more than double the average number available in 2018, and the largest number of options available over the period we examined, which goes back to 2010 (Figure 1). These numbers exclude employer or union-sponsored group plans, Special Needs Plans (SNPs), PACE plans, cost plans, and Medicare-Medicaid plans (MMPs) that are only available to select populations.

Of the 43 Medicare Advantage plans available for individual enrollment, 36 of the plans include prescription drug coverage (MA-PDs), on average.

Total Number of Plans. In total, 3,959 Medicare Advantage plans are available nationwide for individual enrollment in 2024 – a slight decrease in the number of plans (1% decrease; 39 fewer plans) offered in 2023. However, it is the second largest number of plans available over the period we examined, which goes back to 2010 (Figure 2; Appendix Table 1).

HMOs account for more than half (56%) of all Medicare Advantage plans offered in 2024 but have declined as a share of all Medicare Advantage plans since 2017 (71% of plans), while local PPOs are rising as a share of all plans. During this period, the availability of local PPOs has increased from 24% in 2017 to 42% in 2024. The share of regional PPOs has slowly declined from around 3% of plans offered in 2017 to 1% in 2024.

The decline in number of plans varies across states and counties, with the preponderance of the decline occurring in Alabama (20 fewer plans), Illinois (18 fewer plans), and Texas (16 fewer plans) (data not shown), though beneficiaries in Alabama still have a choice of 30 plans on average (down from 32 in 2023), while beneficiaries in Illinois have a choice of 47 plans on average and beneficiaries in Texas have a choice of 49 plans (both down 2 from 2023). Unlike in 2022 and 2023 where two plan options were offered in Alaska, in 2024, there are no plans offered. While there has been an overall decline in the number of plans offered, Colorado has 18 more plans available for 2024 than in 2023. In the remaining states, the number of plans either stayed the same or the growth or decline in plans was 13 or fewer.

While many employers and unions also offer Medicare Advantage plans to their retirees, no information about these 2024 plan offerings is made available by CMS to the public during the Medicare open enrollment period because these plans are administered separately and may have enrollment periods that do not align with the Medicare open enrollment period.

Special Needs Plans (SNPs). In 2024, 1,333 SNPs will be offered nationwide, a 4 percent increase between 2023 and 2024 (Figure 3).

D-SNPs. Nearly two-thirds of SNPs (64%) are designed for people dually eligible for Medicare and Medicaid (D-SNPs). The number of D-SNPs has increased substantially over the past five years, increasing from 465 dual SNPs in 2019 to 851 dual SNPs in 2024, suggesting insurers continue to be drawn to this high-need population.

I-SNPs. The number of SNPs for people who require an institutional-level of care (I-SNPs) nearly doubled from 97 plans in 2018 to 189 plans in 2023, before dropping modestly to 173 plans for 2024. 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 nursing homes for an extended period of time. In 2023, about 100,000 Medicare beneficiaries are enrolled in I-SNPs.

C-SNPs. The number of SNPs offered for people with chronic conditions (C-SNPs) is very similar to 2023 (309 plans in 2024 vs 306 in 2023), more than doubling from 2019 (127 plans). Most C-SNPs focus on people with diabetes, heart disease, or lung conditions, as has been the case since the inception of C-SNPs. For 2024, one firm is offering a C-SNP for people with dementia (compared to two firms in 2023) in four states (California, Florida, Michigan, Virginia). No firms are offering C-SNPs for people with mental health conditions (compared to two firms in 2023), and only one firm is offering a C-SNP for people with HIV/AIDS, the same as 2023. Eight firms are offering C-SNPs for people with end-stage renal disease (up one from 2023).

Variation in the Number of Medicare Advantage Plans, by Geographic Area. Medicare beneficiaries living in metropolitan areas – counties with at least 50,000 people – can choose from 47 Medicare Advantage plans in 2024 on average, substantially more than beneficiaries living in rural or micropolitan areas. Beneficiaries in rural areas – counties with less than 10,000 people – can choose from an average of 27 plans, while beneficiaries in micropolitan areas (10,000 to 50,000 people) can choose from an average of 32 plans.

More than 2.4 million beneficiaries in 29 counties can choose from 75 or more Medicare Advantage plans. Similar to the last two years, the counties with the most plan options are predominantly in Ohio and Pennsylvania. In Ohio, for example, beneficiaries can choose from 80 or more Medicare Advantage plans in 10 counties, including Hamilton County (Cincinnati) and Cuyahoga County (Cleveland). Beneficiaries in Summit County, Ohio (Akron) can choose from 87 Medicare Advantage plans – the most offerings of any county in the US. Beneficiaries living in five counties in Pennsylvania can also choose from 80 or more plans. In California, beneficiaries in Orange County can choose from 78 plans (Figure 4).

In 2024, one-third of Medicare beneficiaries (33%) (in 8 percent of counties), can choose from more than 50 Medicare Advantage plans where they live (Figure 5).

The share of Medicare beneficiaries with a choice of at least 50 Medicare Advantage plans has increased from 1% in 2019 to 33% in 2024.

Unlike in 2022 and 2023, there are no Medicare Advantage plans being offered in any county in Alaska in 2024, which includes about 94,000 beneficiaries. In 2024, less than 1 percent of beneficiaries live in a county with fewer than four Medicare Advantage plans available. Additionally, no Medicare Advantage plans are available in territories other than Puerto Rico.

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 (99.9%) and the vast majority of beneficiaries in micropolitan (99.5%) and rural areas (98.4%). In micropolitan and rural counties, a smaller share of beneficiaries have access to HMOs (93% in micropolitan counties and 96% in rural counties versus over 99% in metropolitan counties) or local PPOs (98% in micropolitan counties and 96% in rural counties versus 99% in metropolitan counties), while a slightly larger share of beneficiaries in non-metropolitan counties have access to regional PPOs (77% in both micropolitan and rural counties versus 73% in metropolitan counties).

Number of Firms

The average Medicare beneficiary is able to choose from plans offered by 8 firms in 2024, one fewer than in 2023 and 2022 (Figure 6). Despite most beneficiaries having access to plans operated by several different firms, enrollment is concentrated in plans operated by UnitedHealthcare and Humana, and together UnitedHealthcare and Humana account for nearly half (47%) of Medicare Advantage enrollment in 2023.

One-third of beneficiaries (33%), in 211 counties, are able to choose from plans offered by 10 or more firms or other sponsors. Fifteen firms are offering Medicare Advantage plans in Butler and Hamilton counties in Ohio, and 14 firms are offering Medicare Advantage plans in 12 counties: 6 in Ohio, 5 in California, and 1 in Arizona (Maricopa). In contrast, 4 percent of beneficiaries live in a county where one to three firms offer Medicare Advantage plans (528 counties). Further, in 130 counties, most of which are rural counties with relatively few Medicare beneficiaries (less than 1 percent of total), only one firm will offer Medicare Advantage plans in 2024.

Availability of Plans by Firm and County. UnitedHealthcare and Humana, the two firms with the most Medicare Advantage enrollees in 2023, have large footprints across the country, offering plans in most counties. Humana is offering plans in 90 percent of counties and UnitedHealthcare is offering plans in 87 percent of counties in 2024, roughly the same as in 2023 (Figure 7).

Most major insurers are also expanding into new counties, with CVS Health expanding in the largest number of counties in 2024 – an increase of 249 counties from 2023 (2,227 counties overall) (Figure 8).

Blue Cross Blue Shield Affiliates are offering plans in 2,604 counties in 2024, an increase of 138 counties from 2023. UnitedHealthcare is offering plans in 2,804 counties in 2024, an increase of 95 counties from 2023, while Humana is offering plans in 2,906 counties in 2024, an increase of 46 counties from 2023. Cigna is offering plans in 603 counties, an increase of 22 counties, and Centene is offering plans in 1,748 counties, an increase of 9 counties; Kaiser Permanente is offering plans in 118 counties, an increase of 2 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 1,276 counties (accounting for 59% of beneficiaries), at least one firm is offering 10 or more plans for individual enrollment. For example, in Bucks and Delaware counties in Pennsylvania, four firms are offering 10 or more plans (Humana, UnitedHealthcare, Blue Cross Blue Shield Affiliates, and CVS Health). In 92 counties, two firms are offering 10 or more plans, and in 28 counties, three firms are offering 10 or more plans.

Blue Cross Blue Shield Affiliates and Humana are offering the most plan options in individual counties. BCBS Affiliates are offering 19 different plan options in seven counties, 17 plan options in 9 counties, and 16 plans in 5 counties. Humana is offering 18 Medicare Advantage plans in three counties, 17 plan options in 1 county, and 16 plan options in 35 counties.

New Market Entrants and Exits

In 2024, three firms (Champion Health Plan, Peak Health, and Verda Health Plan of Texas) entered the market for the first time, while twelve firms exited the market. One new entrant has two new plans available for general enrollment in West Virginia. Two firms are offering C-SNP plans, for people with select chronic conditions in California, Nevada, and Texas. collectively accounting for about 12 percent of the growth in SNPs (Appendix Table 2).

In the last few years, more firms have introduced plans that are either co-branded or are in partnership with another company. For example, in 2024, Alignment Health is offering four plans co-branded with Instacart in 13 counties in California and Nevada. These plans will offer groceries to qualifying beneficiaries with chronic conditions. UnitedHealthcare has partnered with Walgreens over the last few years to offer plans, while Alignment Health has a new partnership with Walgreens for 2024. UnitedHealthcare’s plans with Walgreens in 2024 are available in California, Georgia, Illinois, Missouri, Nevada, Texas, Utah, and Wisconsin, while Alignment Health’s plans with Walgreens in 2024 are offered in Arizona, California, Florida and Texas. Other companies with a partnership that are offering plans in 2024 include Select Health and Kroger and Alignment Health and Rite Aid, though this is not an exhaustive list.

Twelve firms that participated in the Medicare Advantage market in 2023 are not offering plans in 2024. Five of the fourteen firms had low enrollment in 2023 (less than 3,500 enrollees) while five firms either had no enrollment or enrollment of less than 11 people in 2023, one of which was a Medicare Medical Savings Account (MSA) operating in many states.  Two of the firms with slightly higher enrollment had contracts taken over by other insurers.

Premiums

The vast majority of Medicare Advantage plans for individual enrollment (89%) will include prescription drug coverage (MA-PDs), and the share of MA-PDs that charge no premium (other than the Part B premium) is 66% in 2024, the same as in 2023. In addition, 19% of Medicare Advantage plans will offer some reduction in the Part B premium in 2024, similar to the share in 2023. Nearly all beneficiaries (99%) have access to a MA-PD with no additional monthly premium in 2024, the same as in 2023 (99%).

In 2023, 73% of enrollees in MA-PD plans pay no premium other than the Medicare Part B premium of $164.90 per month. Based on enrollment in March 2023, 10% of enrollees pay at least $50 a month, including 3% who pay $100 or more. CMS announced that the average monthly plan premium among all Medicare Advantage enrollees in 2024, including those who pay no premium for their Medicare Advantage plan, is expected to be $18.50 a month. In 2023, 10 percent of Medicare Advantage enrollees are in a plan that offered some reduction in Medicare Part B premiums.

Extra Benefits

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. In 2024, 97% or more individual plans offer some vision, fitness, hearing or dental benefits (Figure 9). Though these benefits are widely available, the scope of coverage for these services varies. For example, a dental benefit may include cleanings and preventive care or more comprehensive coverage, and often is subject to an annual dollar cap on the amount covered by the plan. Plans are not required to report data about utilization of these benefits or associated costs, so it is not clear the extent to which supplemental benefits are used by enrollees.

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 costs 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 majority (83%) of Medicare Advantage plans are offering telehealth in 2024, but a decline from 2023, when 97% of plans offered these benefits.

Other extra benefits that are frequently offered for 2024, similar to the share of plans offering these benefits in 2023, include over the counter items, such as adhesive or elastic bandages (85%), remote access technologies (74%), meal benefits, such as meal delivery (72%), acupuncture (34%), support for caregivers of enrollees (5%), and telemonitoring services (3%). A little more than a third of plans offer transportation benefits for medical needs (36%), down from 43% in 2023, about two in ten plans (22%) offer access to bathroom safety devices, up from 10% in 2023, and nine percent offer in-home support services, down from 14% in 2023. 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 Medicare Advantage Plans with Extra Benefits. Virtually all Medicare beneficiaries live in a county where at least one Medicare Advantage plan available for general enrollment (excluding SNPs) has some extra benefits not covered by traditional Medicare, with over 99% having access to at least one or more plans with dental, fitness, vision, and hearing benefits for 2024. The vast majority of beneficiaries also have access to one or more plans that offer telehealth benefits (over 99%), over the counter items (over 99%), a meal benefit (over 99%), remote access technologies (99%), acupuncture (99%), bathroom safety devices (97%), transportation assistance (96%) but fewer have access to one or more plans that offer in-home support services (72%), caregiver support (44%), or telemonitoring services (20%) .

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 over the counter benefits (94%; up from 86% in 2023), transportation benefits for medical needs (88%; the same as 2023), bathroom safety devices (34%; up from 14% in 2023), and in-home support services (25%; down from 34% in 2023). Similar to plans available for general enrollment, a relatively small share of SNPs offer support for caregivers (6%) or telemonitoring services (2%).

Availability of Special Supplemental Benefits for the Chronically Ill (SSBCI). Beginning in 2020, Medicare Advantage plans have also been able to offer extra benefits to a subset of a plan’s enrollees, that are not primarily health related and are specifically for chronically ill beneficiaries, known as Special Supplemental Benefits for the Chronically Ill (SSBCI). Most individual and SNP Medicare Advantage plans still do not offer these benefits, though more SNP plans generally offer these benefits, particularly food and produce. SSBCI benefits offered in 2024 include food and produce (13.9% for individual plans and 60.0% for SNPs), general supports for living (e.g., housing, utilities) (7.8% in individual plans and 48.0% for SNPs), transportation for non-medical needs (6.1% for individual plans and 29.8% for SNPs), and pest control (3.8% for individual plans and 13.6% for SNPs) (Figure 10).

Discussion

The average Medicare beneficiary has a choice of 43 plans in 2024, the same as in 2023, offered by an average of 8 insurers, one less than in 2023. Medicare Advantage plans can be attractive to beneficiaries because they typically offer extra benefits, such as dental, vision and hearing, often for no additional premium, with the trade-off of more restrictive provider networks and greater use of cost management tools, such as prior authorization. The sheer number of plans presents both opportunities (to shop for better coverage) and challenges (to decipher potentially important differences across plans) although a minority of Medicare Advantage enrollees compare plans during the open enrollment period. Insurers have been drawn to the Medicare Advantage market because it is profitable relative to other health insurance markets, and this comes at a cost to Medicare, in that Medicare currently pays Medicare Advantage 106% of traditional Medicare costs, on average, according to MedPAC. As enrollment continues to climb, it will be increasingly important to assess how well Medicare Advantage is serving beneficiaries in terms of costs, quality, benefits and patient outcomes, as well as how well Medicare’s current payment methodology for Medicare Advantage is working to hold down beneficiary costs and Medicare spending.