In 2023, Medicare Advantage (MA) plan members represented more than half of all Medicare beneficiaries for the first time. In 2024, while penetration continues, there are other trends within MA that home-based care providers should be paying attention to.
Seniors have more options than ever when choosing MA plans. But a few of the top companies continue to gain market share.
Specifically, UnitedHealth Group (NYSE: UNH), Humana Inc. (NYSE: HUM) and CVS Health (NYSE: CVS) – through Aetna – continue to outpace competitors.
Last year, UnitedHealthcare owned 29% of the MA market with 8.9 million beneficiaries; Humana owned 18% of the market with 5.5 million beneficiaries; and CVS Health owned
11% of the market with 3.3 million beneficiaries, according to Kaiser Family Foundation.
Blue Cross Blue Shield plans owned a significant portion of the market, too, with 14% and 4.4 million beneficiaries.
Between 2023 and 2024, the largest plans continued to see growth. UnitedHealthcare gained 478,000 new members, Humana added 412,000 new members and CVS Health added 544,000 members, according to a Chartis analysis.
Meanwhile, Elevance Health’s (NYSE: ELV) beneficiary total dropped by 25,000. Centene (NYSE: CNC) had an even greater fall off, losing 212,000 members.
Cigna (NYSE: CI) also agreed to sell its MA business to Health Care Service Corporation for $3.7 billion.
Over 80% of the 1.7 million new MA beneficiaries went to for-profit plans – such as UnitedHealthcare, Humana and Aetna – according to Chartis.
What’s noteworthy about the biggest players in the MA space is their at-home care ambitions.
UnitedHealth Group is directly involved in home health care. It owns LHC Group and is in the process of acquiring Amedisys. Those are two of the largest home health entities in the country.
Humana owns CenterWell Home Health, also one of the largest home health entities in the country.
CVS Health does not directly own home health assets, but does own the at-home care enabler Signify Health.
Home health providers have generally had difficulty getting fair rates from MA plans for home health services, despite many of their parent companies going after home health assets.
Other trends to consider
For home care providers, these plans’ direction when it comes to supplemental benefits is worth paying attention to.
“Similar to plan options, the prevalence of supplemental benefit offerings (which have increased significantly in recent years) seems to be slowing and even declining for some benefits, suggesting that ‘more is not always better,’” authors of the Chartis analysis wrote. “The proliferation of both plan options and supplemental benefits is driving proposed regulations from the Centers for Medicare & Medicaid Services related to agent/broker compensation, D-SNP integration, and supplemental benefit reporting.”
Experts in the space still generally believe that supplemental benefit utilization – and particularly in-home support services, which home care providers help administer – will hold up. That’s because the plans that are believers in those benefits will continue to lean into them, even if others drop benefits to deal with rate cuts.
But CVS Health CFO Tom Cowhey did acknowledge this week that some supplemental benefits could be on the chopping block.
“What are some of the things that we’re going to need to look at?” Cowhey said at the 45th Annual Raymond James Institutional Investor Conference. “I think supplemental benefits have to be on that list. I think ourselves – and probably all the industry – are going to have to look at all the benefits across the board and decide where it is that we want to cut. But I know that supplemental benefits will be part of that conversation.”
Companies featured in this article:
