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Medicare Advantage 2014 Spotlight: Enrollment Market Update

Overall Trends in Enrollment

Nationwide Enrollment. There are 15.7 million beneficiaries – 30 percent of the Medicare population – enrolled in a Medicare Advantage plan in 2014 (Exhibit 1).1 Between 2013 and 2014, total Medicare Advantage enrollment grew by almost 1.4 million, or 9 percent; since 2010, Medicare Advantage enrollment has increased by 4.6 million beneficiaries or 41 percent from 2010 to 2014. This pattern continues the rapid growth in enrollment that occurred concurrently with the introduction of Part D (prescription drug coverage) in 2006 and other changes in the Medicare Advantage program authorized by the Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003.  Medicare enrollment has continued to grow despite the fact that the average number of plans available to enrollees nationwide declined from a high of 48 plans in 2009 to 20 plans in 2012 and to 18 in 2014, as firms made changes to plans offered under their Medicare Advantage contracts.2

Exhibit 1: Total Medicare Private Health Plan Enrollment, 1999-2014

Exhibit 1: Total Medicare Private Health Plan Enrollment, 1999-2014

Exhibit 2: Share of Medicare Beneficiaries Enrolled in Medicare Advantage Plans, by State, 2014

Exhibit 2: Share of Medicare Beneficiaries Enrolled in Medicare Advantage Plans, by State, 2014

Enrollment by State. Medicare Advantage enrollment continues to vary geographically (Table 1). In 2014, as in at least the prior two years, 6 states (AK, DE, MD, NH, VT and WY) had less than 10 percent of Medicare beneficiaries in Medicare Advantage plans (Exhibit 2). In contrast 18 states (versus 15 in 2013) have 30 percent or more of their beneficiaries enrolled in Medicare Advantage plans, including 3 (MN, OR, and HI) with 40 percent or more enrolled in Medicare Advantage plans.  This variation reflects the urban origins of health maintenance organizations (HMOs) in Medicare Advantage and other factors, such as the history of managed care in the state and the prevalence of employer sponsored insurance for retirees.

Despite such variation, enrollment increased in virtually all states in 2014, with the exception of New Jersey where enrollment declined 2 percent.  Among other states, 13 states experienced a growth in enrollment of 5 percent or less   In 19 states, enrollment grew by 6-10 percent, in 9 states enrollment grew by 11-15 percent and in 7 states enrollment grew by 16 percent or more between 2013 and 2014.  Very high rates of growth (such as 56 percent in Illinois and 45 percent in North Carolina) reflect the influence of the group market, and illustrate how  a single change in coverage for an employment-based retiree group can move relatively large numbers of people within a state. Each of these states added over 100,000 group enrollees to Medicare Advantage between March 2013 and 2014.  In most other states, enrollment in group plans had a far more modest effect on the growth in Medicare Advantage enrollment.

Table 1.  Medicare Advantage Enrollment and Penetration Rate, by State, 2013-2014
State 2013 Total Enrollment 2014 Total Enrollment Change in Total Enrollment, 2013-2014 Percent Change in Enrollment, 2013-2014 2013 Penetration Rate 2014 Penetration Rate
Total U.S. 14,361,615 15,732,081 1,370,466 10% 28% 30%
Alabama 203,951 220,640 16,689 8% 22% 24%
Alaska N/A N/A N/A N/A N/A N/A
Arizona 384,851 401,626 16,775 4% 38% 38%
Arkansas 98,322 107,713 9,391 10% 17% 19%
California 1,937,350 2,061,617 124,267 6% 37% 38%
Colorado 244,356 263,788 19,432 8% 35% 36%
Connecticut 137,253 146,372 9,119 7% 23% 24%
Delaware 10,941 12,623 1,682 15% 7% 7%
District of Columbia 8,654 9,714 1,060 12% 10% 11%
Florida 1,318,740 1,438,325 119,585 9% 36% 38%
Georgia 350,142 404,628 54,486 16% 25% 28%
Hawaii 103,346 108,143 4,797 5% 46% 46%
Idaho 74,871 81,440 6,569 9% 30% 33%
Illinois 209,200 326,678 117,478 56% 11% 16%
Indiana 224,875 244,970 20,095 9% 21% 22%
Iowa 74,520 77,032 2,512 3% 14% 14%
Kansas 54,329 59,018 4,689 9% 12% 13%
Kentucky 178,945 198,052 19,107 11% 22% 24%
Louisiana 193,638 213,280 19,642 10% 26% 28%
Maine 49,347 58,234 8,887 18% 17% 20%
Maryland 73,239 76,464 3,225 4% 8% 9%
Massachusetts 209,147 229,400 20,253 10% 18% 20%
Michigan 478,923 547,372 68,449 14% 27% 30%
Minnesota 415,638 448,301 32,663 8% 49% 51%
Mississippi 64,000 69,962 5,962 9% 12% 13%
Missouri 257,164 285,066 27,902 11% 24% 26%
Montana 27,229 31,125 3,896 14% 15% 17%
Nebraska 33,228 33,507 279 1% 12% 13%
Nevada 126,441 135,599 9,158 7% 32% 33%
New Hampshire 12,554 15,905 3,351 27% 5% 6%
New Jersey 223,161 219,494 -3,667 -2% 16% 15%
New Mexico 98,198 107,064 8,866 9% 29% 30%
New York 1,062,329 1,151,620 89,291 8% 33% 35%
North Carolina 328,020 475,432 147,412 45% 20% 28%
North Dakota 13,716 15,202 1,486 11% 12% 14%
Ohio 755,580 794,226 38,646 5% 37% 38%
Oklahoma 102,224 106,706 4,482 4% 16% 16%
Oregon 286,306 305,794 19,488 7% 42% 43%
Pennsylvania 939,496 971,144 31,648 3% 39% 39%
Rhode Island 68,306 70,627 2,321 3% 35% 36%
South Carolina 167,292 193,641 26,349 16% 20% 22%
South Dakota 18,781 22,242 3,461 18% 13% 15%
Tennessee 338,124 376,577 38,453 11% 29% 32%
Texas 889,551 990,399 100,848 11% 27% 29%
Utah 101,751 107,139 5,388 5% 33% 34%
Vermont 8,199 8,368 169 2% 7% 7%
Virginia 181,455 196,993 15,538 9% 15% 15%
Washington 305,289 329,087 23,798 8% 28% 29%
West Virginia 83,922 96,604 12,682 15% 21% 24%
Wisconsin 324,912 352,842 27,930 9% 33% 35%
Wyoming 1,940 1,997 57 3% 3% 3%
NOTE: Includes employer-sponsored plans, special needs plans, and other private plans.  N/A indicates too few (less than 50) enrollees to report.  Total U.S. includes Puerto Rico.
SOURCE:  MPR/Kaiser Family Foundation analysis of CMS Medicare Advantage enrollment and Landscape files, 2013-2014.

 

Introduction Trends in Enrollment by Plan Type