Update 3/15/23: At the request of Humana's Sales Integrity Dept., I've removed their logo from this blog entry.
Before I start, let me say that I've never been a fan of Medicare Advantage, at least as its currently structured, for a number of reasons. I am not advocating for the Medicare Advantage system--again, as currently structured--to be expanded.
Having said that, the trend has been inevitable: Medicare Advantage has steadily increased its share of total Medicare enrollment for years, from 19% in 2007 to 48% in 2022 according to the Kaiser Family Foundation (the official October 2022 CMS Medicare enrollment report puts it a bit lower, at 46.3%). Either way, the point is that MA is on track to overtake traditional, "fee for service" Medicare within the next few years and become the default choice for new enrollees.
Today, the Centers for Medicare & Medicaid Services (CMS) released the latest enrollment figures for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). These programs serve as key connectors to care for more millions of Americans.
As of August 2022, 64,942,984 people are enrolled in Medicare. This is an increase of 111,278 since the last report.
34,939,872 are enrolled in Original Medicare.
30,003,112 are enrolled in Medicare Advantage or other health plans. This includes enrollment in Medicare Advantage plans with and without prescription drug coverage.
...As of August 2022, 90,550,412 people are enrolled in Medicaid and CHIP. This is an increase of 587,411 since the last report.
Believe me, I was certain that I had finally gotten this year's Medical Loss Ratio (MLR) rebate project out of my system. I really was.
However, there was one other MLR-related issue which I've wondered about for years: The ACA requires that carriers who sell policies in the Individual and Small Group markets spend at least 80% of the premium revenue on actual medical claims (limiting them to a 20% gross margin), and 85% on the Large Group market (limiting them to 15% gross).
That accounts for around 165 million people, give or take...roughly 50% of the total U.S. population...but what about the other private (or at least semi-private) insurance markets? I'm referring, of course, to privately-administered Medicare and Medicaid plans...aka Medicare Advantage and Managed Care Organizations (MCOs).
Combined, the Medicaid and CHIP programs have around 72.5 million Americans enrolled in them as of December 2018. However, the vast majority--over 80% of them--are actually enrolled in privately managed Medicaid programs. Managed Care Organizations (MCOs) are private health insurance companies which states contract with to handle the administration and management. In some cases this works out reasonably well. In others...not so much: