While most older adults and people with disabilities can choose from among 30 or more Medicare Advantage plans offered through around eight different insurers, a new Kaiser Family Foundation report shows that most Medicare Advantage markets are dominated by one or two insurers. The result is that your coverage in Medicare Advantage is unreliable.
What risks do high concentration markets in Medicare Advantage pose? They can be highly unreliable, undermining enrollees’ continuity of care. Medicare Advantage enrollees cannot count on stable benefits, provider networks or out-of-pocket costs.
Insurers can pull out of the market altogether because they are unhappy with their profit margins. Or, they can switch up their provider networks and other benefits significantly. Or, provider groups can pull out of Medicare Advantage networks. Moreover, they can pay their insurance agents to steer you away from traditional Medicare, the government-administered Medicare program that covers your care from almost all doctors and hospitals in the country.
What’s more, high concentration undermines competition. If there’s only one or two insurers in the market serving most enrollees, insurers might not need to keep copayments down to lure you to join, or they might not need to offer extra benefits or enlist top specialists in their networks.
Virtually all Medicare Advantage counties (97 percent) are highly concentrated (2,524) or very highly concentrated (574). Two percent of counties (72) have virtually no Medicare Advantage enrollment. Close to nine in ten people with Medicare (89 percent) are in highly concentrated markets.
Rural counties have the highest concentration. Nearly four in ten of them (39 percent) are very highly concentrated, whereas only six percent of urban counties were very highly concentrated. But, 90 percent of people with Medicare (54.3 million) are in counties where one or two insurers dominate the market, with more than half of all enrollees.
UnitedHealth and Humana enroll more people with Medicare in their Medicare Advantage plans than other insurers in more than half of the counties. UnitedHealth has the greatest enrollment in two out of three counties. UnitedHealth enrolled 41 percent of people. Humana enrolled 25 percent.
In some big counties, such as Dallas, Texas, Salt Lake City, Utah and Milwaukee, Wisconsin, more than half of Medicare Advantage enrollees were enrolled with the same health insurer.
Here’s more from Just Care:
- Ten ways Medicare Advantage plans differ from traditional Medicare
- Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan
- You still can’t trust Medicare Advantage plan provider directories
- OIG finds widespread inappropriate care denials in Medicare Advantage
- UnitedHealth deprives members of critical rehabilitation care
