A Brief Analysis of Year-Over-Year Medicare Advantage and PDP Enrollment Trends

 

March 31, 2020

As of March 1, 2020, total Medicare Advantage (MA), including Medicare Advantage with Prescription Drug Plan (MA-PD) membership, stood at 24,750,719 with a net gain of 2,096,443 members from March 1, 2019.  Medicare stand-alone prescription drug plans (PDPs) covered 25,194,944 members as of March 1, 2020, a net decrease of 364,857 from the previous year. This brief assesses Medicare Advantage and PDP performance, market share and market penetration by state as of March 1, 2020.

Medicare Advantage Membership

Medicare Advantage (MA) market penetration remains strong; however, there is still abundant opportunity for growth with only 36% of the 68.6 million people eligible for Medicare.  According to CMS Medicare Advantage enrollment reports aggregated by MFA in Medicare Business Online™, total Medicare Advantage plan enrollment as of March 1, 2020 increased 9.3% from March 2019.  The top ten companies, each with more than 150,000 members in this segment, collectively provide coverage for 75.5% of the market.  Per the reference tables below, most leading MA companies realized year-over-year growth with the exception of Centene.  The overall net gain for the ten companies was over 10%.

MA Leading Plan Performance

UnitedHealth continues to dominate in this highly competitive segment.  With approximately 6.35 million enrolled, UnitedHealth commands 25.7% of the Medicare Advantage market.  Humana ranks second with 18% market share and nearly 4.46 million lives.  CVS maintains the third position, enrolling over 2.6 million, and Kaiser Foundation Group follows with over 1.68 million lives.

 

March 2020 Top 10 MA Organizations
Parent	Mar-19	Mar-20	Percent Growth	March 2020 Market Share
UNITEDHEALTH	5,843,132	6,351,706	8.7%	25.7%
HUMANA	3,960,480	4,457,735	12.6%	18.0%
CVS	2,255,535	2,612,689	15.8%	10.6%
KAISER	1,633,597	1,681,235	2.9%	6.8%
ANTHEM	1,129,799	1,326,252	17.4%	5.4%
BCBS OF MI	520,824	591,631	13.6%	2.4%
WELLCARE	553,932	586,089	5.8%	2.4%
CIGNA	442,745	508,825	14.9%	2.1%
CENTENE	306,291	290,501	-5.2%	1.2%
HIGHMARK	279,762	285,142	1.9%	1.2%
Subtotal Top 10	16,926,097	18,691,805	10.4%	75.5%
All Others	5,728,179	6,058,914	5.8%	24.5%
Total	22,654,276	24,750,719	9.3%	100.0%
Source: Medicare Business Online, Mark Farrah Associates, presenting data from CMS enrollment reports

 

The chart below indicates membership gains were considerable for the leaders in this segment. UnitedHealth’s growth continues to raise the bar for MA plan competition. UnitedHealth reported the largest increase in membership, adding over 508,000 members year-over-year, for a net gain of 8.7%.  Humana experienced the second largest gains with over 497,000 new members.  CVS and Anthem gained over 357,000 and 196,000 new members, respectively.   

 

MA Organizations with the Largest Gains from March 2019 to March 2020
Parent	Mar-19	Mar-20	Growth 2019-2020	Percent Change
UNITEDHEALTH	5,843,132	6,351,706	508,574	8.7%
HUMANA	3,960,480	4,457,735	497,255	12.6%
CVS	2,255,535	2,612,689	357,154	15.8%
ANTHEM	1,129,799	1,326,252	196,453	17.4%
BCBS OF MI	520,824	591,631	70,807	13.6%
CIGNA	442,745	508,825	66,080	14.9%
KAISER	1,633,597	1,681,235	47,638	2.9%
WELLCARE	553,932	586,089	32,157	5.8%
HEALTHFIRST	161,653	192,150	30,497	18.9%
SPECTRUM HEALTH	151,718	177,990	26,272	17.3%
Total	16,653,415	18,486,302	1,832,887	11.0%
Source: Medicare Business Online, Mark Farrah Associates, presenting data from CMS enrollment reports

It is important to note that MA enrollment counts by company or geography for the same reporting period may be slightly different, depending on the CMS enrollment source.  CMS county-level reports do not output enrollment for plans with 10 or fewer members per county.  There may likely be additional competitive shifts in enrollment and market observations through March.

MA Plan Types

HMOs, including those with point-of-service options, remain the dominant plan type.  As of March 1, 2020, 14.7 million of all MA members were enrolled in an HMO plan.  PPOs, including local and regional plans, covered approximately 9 million MA enrollees.  Enrollment for the Dual eligible population, or Medicare-Medicaid Plans (MMPs), stood at over 378,000 as CMS and state Medicaid agencies continue to build new programs.  Private-fee-for-service (PFFS) and "Other" plan types, including Cost or Medical Savings options, comprised 1.3% of all MA members. 

MA Enrollment Growth by State

 

 

As of March 1, 2020, Medicare Advantage enrollment increased in all contiguous states.  Overall, a net membership gain of approximately 2.1 million was seen nationally.  Florida, Texas, California, Michigan, and New York all experienced significant enrollment gains with increases of 100,000 members or more.  Florida experienced the most sizeable year-over-year increase of nearly 169,000 members. 

Stand-alone Prescription Drug Plan Enrollment

Stand-alone prescription drug plans (PDPs), also referred to as Medicare Part D stand-alone plans, enrolled nearly 25.2 million people as of March 1, 2020, a decrease of 364,857 enrollees from March 2019.  PDP plans provide prescription drug coverage for nearly 37% of the 68.7 million people eligible for Medicare.  Enrollment in products sold to individuals was 20,243,444 in March 2020, a decrease of 330,467, year-over-year.   Only 4.56 million Medicare beneficiaries were enrolled in employer group PDPs as of March 1, 2020, a decline of approximately 19,000 members since March 2019.  It is important to note this assessment is reporting on Stand-alone PDP members only, and Medicare Advantage with prescription drug plan (MA-PD) members are not included in this analysis.

 

 

PDP Leading Plan Performance

There are currently 48 organizations competing in Medicare stand-alone prescription drug plans (PDPs) as of March 2020.  Six companies have greater than 800,000 members and command 91% of the PDP market.  Five of these plans control 87% of the market covering 2 million members or more. Per the chart below, CVS Group covers the largest number of people in PDPs; however, CVS saw a 33.3% decrease in enrollment between March 2019 and March 2020 after selling Aetna’s PDP business to WellCare in 2019. Consequently, WellCare  experienced the most sizable percentage of year-over-year enrollment growth with a 171.6% membership gain. 

 

March 2020 Top PDP Organizations
Parent	Mar-19	Mar-20	Percent Growth	March 2020 Market Share
CVS	8,519,821	5,681,399	-33.3%	22.5%
UNITEDHEALTH	5,159,930	4,847,038	-6.1%	19.2%
WELLCARE	1,626,264	4,416,776	171.6%	17.5%
HUMANA	4,339,785	3,779,400	-12.9%	15.0%
CIGNA	3,308,955	3,303,491	-0.2%	13.1%
ENVISION INS	634,499	879,524	38.6%	3.5%
Subtotal	23,589,254	22,907,628	-2.9%	90.9%
All Others	1,970,547	2,287,316	16.1%	9.1%
Total	25,559,801	25,194,944	-1.4%	100.0%
Source: Medicare Business Online, Mark Farrah Associates, presenting data from CMS enrollment reports