Fall Open Enrollment Continues with Choices for Beneficiaries and Benefits for Plans

Medicare’s annual Fall Open Enrollment (FOE) period runs from October 15 to December 7. It is the time of year when people can make unrestricted changes to their Medicare Advantage (MA) and Part D prescription drug coverage.

For many, this annual process of comparing a seemingly endless number of plan options is overwhelming. Plans can differ on everything from costs to coverage, making detailed analysis both critical and difficult. Prolific and deceptive marketing tactics can worsen beneficiary decision-making challenges during FOE. This can all lead to poor or no coverage choices, which in turn can have serious consequences like higher costs and problems accessing care.

A new KFF analysis of the 2024 MA landscape suggests this year’s FOE evaluations will remain complex. For 2024, the average beneficiary can again choose from 43 MA plans, over twice as many as in 2018. There are availability variances by geographic area, but overall, one-third (33%) of Medicare beneficiaries will have access to more than 50 MA plans—up from 1% in 2019. MA enrollment has also surged in recent years, more than doubling over the last decade. Today over half (51%) of all Medicare beneficiaries—31 million people—are enrolled in an MA plan.

As MA enrollment and plan numbers grow, plan ownership and firm market share are becoming increasingly concentrated, heightening concerns about an inadequately competitive marketplace. On average, beneficiaries can select from plans offered by 8 different firms, one fewer than in 2023. Companies are saturating individual geographic areas; nearly 60% of beneficiaries live in counties where at least one firm is offering 10 or more plans. Two companies—UnitedHealthcare and Humana—maintain control over a significant portion of the landscape; their plans currently account for nearly half (47%) of MA enrollment.

Plan promises of supplemental benefits remain prominent. Though scope can vary significantly, in 2024 nearly all beneficiaries will have access to MA plans offering some vision (99%), fitness (98%), hearing (98%) or dental (97%) coverage. When meaningfully delivered, such services have the potential to improve health outcomes and lower costs. However, it is unclear how or if these benefits are truly working for enrollees because data about their delivery and utilization, as well as about the consumer experience, is severely lacking. They nevertheless remain a powerful plan marketing tool: The Commonwealth Fund estimates that 24% of people who choose MA do so because of these extra services.

The report notes that “Insurers have been drawn to the Medicare Advantage market because it is profitable relative to other health insurance markets, and this comes at a cost to Medicare, in that Medicare currently pays Medicare Advantage 106% of traditional Medicare costs, on average, according to MedPAC. As enrollment continues to climb, it will be increasingly important to assess how well Medicare Advantage is serving beneficiaries in terms of costs, quality, benefits and patient outcomes, as well as how well Medicare’s current payment methodology for Medicare Advantage is working to hold down beneficiary costs and Medicare spending.”

The Medicare Rights Center understands the importance of ensuring Medicare is strong now and in the future. The research from independent experts is clear: Medicare overpays MA plans by billions of dollars each year. This misallocation of resources is negatively impacting Medicare’s finances and long-term sustainability, as well as driving up beneficiary premiums and taxpayer costs.We will continue to advocate for greater MA payment accuracy and plan accountability, and for changes to improve the enrollee experience, such as tougher consumer protections, enhanced benefits, better access and affordability, and more streamlined processes.

Read the KFF report, Medicare Advantage 2024 Spotlight: First Look.