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A Brief Analysis of the Medicare Market in Six Major Metro Areas

 

December 13, 2021

Total current Medicare Advantage (MA) membership is 28.0 million, representing 44% of the 63.6 million Americans eligible for Medicare. Within Metropolitan Statistical Areas (MSAs), where 83% of Medicare Eligible people reside, Medicare Advantage penetration can be significantly higher. As the number of Medicare beneficiaries increases, health plans are looking for new and under penetrated markets in which to expand. Companies also evaluate their own market positions against competitors to assess ongoing relative market opportunity. Market share at the county or MSA level is often analyzed to gain a more nuanced competitive picture of specific markets. This brief presents an overview of Medicare market demographics and market share data, with a focus on health plan market positions for six major MSAs in the U.S.

Competition and Market Share

Mark Farrah Associates (MFA) analyzed Medicare and Medicare Advantage (MA) market enrollment figures included in the Health Coverage Portal™ and  Medicare Business Online™ by major metropolitan statistical areas (MSAs) in the United States. Data for total Medicare Eligibles, those enrolled in Original Medicare (without Part C), and those enrolled in Medicare Advantage (Part C) are presented in the following table for the major MSAs with over a million seniors currently eligible for Medicare. These six areas represent the largest metropolitan markets in the country for companies offering MA plans.

 

Metropolitan Area

Medicare Eligibles as of 11/1/2021

Original Medicare Enrollment as of  6/30/2021

Original Medicare Penetration 

Medicare Advantage Enrollment as of 11/1/2021

Medicare Advantage Penetration

New York - Newark- Jersey City

3,393,467 

2,039,390 

60.1% 

1,349,275 

39.8% 

Los Angeles - Long Beach - Anaheim

2,081,982 

957,202 

46.0% 

1,114,838 

53.5% 

Chicago- Naperville - Elgin

1,585,012 

1,037,061 

65.4% 

546,518 

34.5% 

Philadelphia - Camden - Wilmington 

1,174,560 

737,249 

62.8% 

431,452 

36.7% 

Miami - Fort Lauderdale - West Palm Beach

1,161,029 

448,821 

38.7% 

715,329 

61.6% 

Dallas - Fort Worth - Arlington

1,019,546 

548,174 

53.8% 

466,813 

45.8% 

Subtotal - Top 5 MSA

 10,415,596 

5,767,897 

55.4% 

4,624,225 

44.4% 

All Other MSA

42,242,788 

22,658,943 

53.6% 

19,462,120 

46.1% 

Total - MSA

52,658,384 

28,426,840 

54.0% 

24,086,345 

45.7% 

All Other - Non MSA

10,943,131 

6,972,964 

63.7% 

3,914,156 

35.8% 

Total 

63,601,515 

35,399,804 

55.7% 

28,000,501 

44.0% 

 Source: Medicare Business Online™, Mark Farrah Associates, presenting data from CMS enrollment reports

 

In addition to market size represented above, market share can be used to analyze insurance preferences between original Medicare and MA plans. Senior plan choices vary due to a wide array of reasons and concerns. However, senior behavior can be analyzed utilizing penetration rates at a regional level. MFA calculated the penetration rate for original Medicare and MA plans by dividing enrollees by the number of those eligible for Medicare.

As shown below, original Medicare and MA penetration rates vary across the top six MSAs. Miami had the highest penetration rate of the top six MSAs in the MA market at 61.6% and the lowest original Medicare penetration rate at 38.7%. Los Angeles also had an above average MA rate at 53.5%. The Chicago MSA had the highest original Medicare rate among the top six MSAs, at 65.4%, and the lowest MA penetration rate of 34.5%. The lower MA penetration in Chicago was partly due to the popularity of Individual Medicare Supplement plans in Illinois.

 

 

The below table indicates the top MA companies and their corresponding market share in each of the top MSAs, based upon MFA’s Medicare Business Online™ . UnitedHealth Group continued to have a strong presence in five of the six largest MSAs. In the Philadelphia MSA, UnitedHealth Group ranked fourth, behind Cigna. Humana also had a significant presence in the selected MSAs and was the leading carrier in the Miami and Chicago markets, as of November 1, 2021.

 

Top Medicare Advantage Companies

Medicare Advantage Enrollment as of 11/1/2021

Medicare Advantage Market Share as of 11/1/2021

New York - Newark - Jersey City
   
 UNITEDHEALTH GRP

364,046 

27.0% 

 CVS GRP

263,366 

19.5% 

Los Angeles - Long Beach - Anaheim 
   
 KAISER FOUNDATION

370,069 

33.2% 

 UNITEDHEALTH GRP

144,366 

12.9% 

Chicago - Naperville - Elgin
   
 HUMANA GRP

163,653 

29.9% 

 UNITEDHEATLH GRP

151,098 

27.6% 

Philadelphia - Camden - Wilmington
   
 CVS GRP

124,331 

28.8% 

 INDEPENDENCE BLUE  CROSS GRP

112,004 

26.0% 

Miami - Fort Lauderdale - West Palm Beach
   
 HUMANA GRP

249,472 

34.9% 

 UNITEDHEALTH GRP

156,223 

21.8% 

Dallas - Fort Worth - Arlington
   
 UNITEDHEATLH GRP

276,534 

59.2% 

 HUMANA GRP

75,496 

16.2% 

 Source: Medicare Business Online™, Mark Farrah Associates, presenting data from CMS enrollment reports


About Mark Farrah Associates (MFA)

Mark Farrah Associates (MFA) is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry. Our product portfolio includes Health Coverage Portal™, County Health Coverage™, Medicare Business Online™, Medicare Benefits Analyzer™, 5500 Employer Health PLUS, and Health Plans USA™. For more information about these products, refer to the informational videos and brochures, available under the Our Products section of the website (www.markfarrah.com) or call 724-338-4100.

Healthcare Business Strategy is a FREE monthly brief that presents analysis of important issues and developments affecting healthcare business today. If you would like to be added to our email distribution list, please submit your email address to the "Subscribe to MFA Briefs" section at the bottom of this page. Mark Farrah Associates will continue to analyze and report on important health insurance segment performance and related topics. Stay tuned for future analysis briefs with valuable insights about the health care industry.

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