Medicare Supplement Enrollment Trends and Plan Performance Insights


May 26, 2022

Medicare Supplement products (also known as Medigap) continue to remain a viable and stable alternative to Medicare Advantage options for seniors looking to offset the out-of-pocket costs of traditional Medicare coverage. In 2021, Medicare Supplement carriers experienced consistent total membership, with more and more seniors aging into and choosing retirement. Based on performance data filed in annual financial statements from the NAIC (National Association of Insurance Commissioners), enrollment in Medicare Supplement plans was 13.928 million. When factoring in a small number of plans with just 23,721 members that had not yet filed when this analysis was conducted, year-over-year enrollment growth remained relatively flat. This brief provides an overview of the Medicare Supplement market with insights about competitive positioning and standardized plan type preferences.



Mark Farrah Associates (MFA) identified 182 distinct carriers that filed annual data with the NAIC as of December 31, 2021. Breakdowns of in-force policies show that carriers issued policies to 4.8 million members in the last three years. Carriers reported an aggregate of over 9.1 million members covered by in-force older policies that had been issued prior to the year 2019. Please note that MFA analysts determined Transamerica (Aegon US Holding Group) underreported 2020 Lives Older than 3 Years by approximately 100,000 in 2020. MFA has adjusted membership data for this reporting error to allow for more accurate trend reporting in this brief.



Among standardized Plans A-N, Plan F covers the annual Medicare Part B deductible and offers the most comprehensive benefits. Plan F enrolled approximately 5.7 million Med Supp members and accounted for 41% of the market in 2021; dropping from 6.2 million in 2020. On January 1, 2020, Plan F (and Plan C) ceased to be an option for newly eligible Medicare enrollees. Plan G provides a high-deductible option for new beneficiaries and continued to experience year-over-year increases, enrolling 4.3 million members in 2021, from 3.7 million members in 2020. Be advised that the Transamerica (Aegon US Holding Group) underreporting issue may have impacted this data, as well.    

**Note Plan type “P” for Pre-Standardized is used for policies issued prior to the enactment of the Omnibus Reconciliation Act (OBRA) of 1990, which standardized benefits for Medicare Supplement plan types. Plan type “O” or “Other” is used by carriers in a few states including Massachusetts, Minnesota, and Wisconsin that receive waivers to the standardized Medicare Supplement regulations.



Med Supp plans collectively earned approximately $34.3 billion in premiums and incurred $26.5 billion in claims during 2021. The aggregate loss ratio (incurred claims as a percent of earned premiums) was 77.3% in 2021; an increase from 72.3% in 2020. This indicates that medical claims are continuing to steadily increase and recover from the impact of Covid-related restrictions experienced by both healthcare providers and seniors throughout 2020.



As of December 31, 2021, the top 10 Medicare Supplement companies comprised 70% of the market with over 9.7 million members. UnitedHealth, with its longstanding contract with AARP, continued to lead in this segment with 4.4 million members, and commands 31.6% of the market. Mutual of Omaha ranked second with 9.8% market share and approximately 1.36 million members. CVS was the third largest Medigap plan in 2021, with over 1.1 million enrolled. Anthem ranked fourth with almost 693,000 members. Amongst the segment leaders, CVS experienced the most growth, with an 18.7% increase over the last year, while CNO Financial continued to report larger than average declines in membership.   


With over 64 million Medicare beneficiaries residing in the U.S., Medicare Supplement insurers continue to diversify their senior market portfolios to leverage opportunities across all product lines and expand product options to keep up with industry trends. Mark Farrah Associates will continue to monitor enrollment and plan performance in this competitive segment.

About Med Supp Market Data

Med Supp Market Data, a subscription option through Mark Farrah Associates’ Health Coverage Portal™, presents the latest market share and financial performance data for Medicare Supplement plans. The product includes state-by-state membership, premiums, claims and loss ratios for plans nationwide. Online tables also include claims contacts as reported in the financial statements filed with the National Association of Insurance Commissioners (NAIC).  California managed care plans do not file financial statements with the NAIC and are not included in this analysis. For more information about Med Supp Market Data, please visit our website or call 724.338.4100.

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 or call 724-338-4100. Follow us on LinkedIn!

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