KFF has issued a report entitled “Medicare Advantage in 2024: Enrollment Update and Key Trends.” Some of the key findings in the report include:
- 54% of Medicare the Medicare eligible population is enrolled in a Medicare Advantage plan, amounting to 34 million people
- In seven states (Alabama, Connecticut, Michigan, Hawaii, Florida and Rhode Island) 60% or more of the eligible population is enrolled in Medicare Advantage plans
- Between 2023 and 2024, total Medical Advantage enrollment grew by 2.1 million people, a 7% growth rate
- Medicare Advantage enrollment is highly concentrated, with 47% of Medicare Advantage enrollees in a plan offered by either UnitedHealthcare or Humana
- Medicare Advantage enrolls a disproportionate share of people of color and includes an increasing number of dual Medicare/Medicaid beneficiaries
Citing research from the Medicare Payment Advisory Commission (MedPAC), the report pointed out that CMS pays 122% more to Medicare Advantage plans that it spends on similar beneficiaries in traditional fee-for-service Medicare, which translates to an estimated $83 billion in higher spending in 2024. As a result, the report noted:
As Medicare Advantage takes on a more dominant presence in the Medicare program, and with current payments to plans higher for Medicare Advantage than for traditional Medicare for similar beneficiaries, policymakers have become increasingly focused on how well Medicare’s current payment methodology for Medicare Advantage is working to enhance efficiency and hold down beneficiary costs and Medicare spending.
The report also points out that “Medicare Advantage plans have limited provider networks and apply cost management tools such as prior authorization, which traditional Medicare does not.”
Whatley Kallas, LLP’s provider clients have expressed increased frustration with the administrative burden required by Medicare Advantage plan prior authorization and appeal processes. In addition, our clients have experienced increased denials and underpayments by Medicare Advantage plans. We are pursuing claims against Medicare Advantage plans on behalf of many of our hospital and other provider clients.