Half of Eligible Medicare Beneficiaries Now Enrolled in Private MA Plans

KFF reported that data released from the Centers for Medicare & Medicaid Services (CMS), shows Medicare Advantage (MA) now provides Medicare coverage for more than half of its eligible beneficiaries. 

As of January 2023, 30.19 million of the 59.82 million people with both Medicare Part A and Part B were enrolled in a private plan. MA covers Medicare Part A and Part B benefits, usually with no additional premium.

“Enrollment in Medicare Advantage has increased dramatically in recent years. In 2007, less than one in five (19%) eligible Medicare beneficiaries were enrolled in a private plan,” KFF reported. “The growth in enrollment is due to a number of factors, including the attraction of extra benefits offered by most plans, such as vision, hearing, and dental services, and the potential for lower out-of-pocket spending, particularly compared to traditional Medicare without supplemental coverage. Medicare Advantage plans also offer the simplicity of one-stop shopping, in that enrollees do not need a separate Part D prescription drug plan or supplemental coverage.

“At the same time, Medicare Advantage plans typically use tools to manage utilization and costs that may limit access to care, such as prior authorization requirements and referrals for specialists and mental health providers. For example, in 2021, Medicare Advantage enrollees submitted 35 million prior authorization requests. In addition, Medicare Advantage plans generally require enrollees to receive care from in-network providers or pay more out-of-pocket for out-of-network care.”