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Medicare Advantage  Enrollment Trends

There are continually increasing populations of people who become eligible for Original Medicare and Medicare Advantage plans each year in the United States. Since 2006, the amount of enrollees for Medicare Advantage plans has grown steadily.  In 2022, more than 28 million people are enrolled in a Medicare Advantage plan, accounting for nearly half or 48 percent of the eligible Medicare population. This number also accounts for nearly half of the federal Medicare spending.  Let’s explore the Medicare Advantage enrollment trends.

In 2022, the average Medicare beneficiary has access to nearly 40 Medicare Advantage plans, which is the largest number of plans available in over a decade. This looks like 2.2 million new beneficiaries between 2021 and 2022, which is an eight percent increase in enrollees.

Employer Group Versus Individual Plans

In 2022, of the 28.4 million beneficiaries enrolled in Medicare Advantage.   The smallest percentage were enrolled in special needs plans, at a mere 16%. The next smallest group of beneficiaries was those enrolled in union-sponsored or employer-offered Medicare Advantage plans.   These account for 18% of the total. The largest group of beneficiaries by far is those in individual plans –  open for general enrollment.   This group makes up 66% of the 28.4 million beneficiaries. That is about two thirds of this group, or approximately 18.7 million people. Since 2021, that is an increase of about 1.3 million enrollees. However, the share of those in individual plans open for general enrollment has not increased.  It remains steady at about two thirds of the enrollment since 2018.

Medicare Advantage Plans By State

The share of Medicare beneficiaries who are enrolled in Medicare Advantage Plans varies greatly by state and has a very wide range of percentages across the country. However, in 25 of the states, at least half of those eligible for Medicare Advantage plans are enrolled in them. The more rural a state is, the more likely it is to have lower funding for Medicare and lower enrollment in Medicare Advantage plans. South Dakota, North Dakota, Wyoming, and Arkansas are the states with the lowest Medicare Advantage enrollment, which is less than twenty percent, or fewer than one fifth of eligible beneficiaries. Puerto Rico, on the other hand, has the highest percentage of enrolled beneficiaries, with 93% of Medicare beneficiaries also enrolled in a Medicare Advantage plan. This is largely thought to be due to policy choice, as many people in Puerto Rico are dually enrolled automatically in Medicare and Medicaid.

Licensed agents – Medicare Advantage Enrollment Trends

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Medicare Annual Enrollment 2023

As we get closer to the end of the year, many people start thinking about the Medicare Annual Enrollment 2023.  During this time of the year, you can make changes to your Medicare coverage for the upcoming year.   It is important to note; each year Medicare plans change.  Some plans add benefits to a plan or change the way they cover a medication.  Whether you’re a first-time Medicare beneficiary or have been on Medicare for years, you should check your plan each year to stay informed about the changes that may effect your coverage for the following year.

When is Annual Enrollment 2023:

Medicare Annual Enrollment begins October 15, 2022 and ends on December 7, 2022.  During this time, you’ll be able to make changes to your Medicare coverage for the upcoming year.

What changes can I make during  the Medicare AEP

1. Beneficiaries of  Original Medicare may change to a Medicare Advantage plan.
2. If you are on a Medicare Advantage plan you can change to Original Medicare.
3. You may decide to enroll in a PDP (Part D, prescription drug plan).
4. You can also change from one Medicare Advantage plan to another.
5. Some people switch from one PDP plan to another.
6. Other individuals may choose to drop their Part D coverage altogether.

Things to consider before changing your Medicare coverage:

1. Each year you should review your healthcare coverage. Many people find it invaluable to enlist the expertise of a licensed insurance agent for this.  Because there are so many plan options it can get confusing.  Make sure you understand your current coverage so it will be easier to compare it with the best plan choices for next year.
2. Think about your health care needs especially if they have changed.   If possible, try to consider what you may need in the upcoming year.
3. If you are on a Medicare advantage plan, be sure to check that your health care providers will still be in-network.  Providers and facilities (hospitals, labs, out patient clinics) do make changes during the year and if you skip this step, it could be very costly.
4. Members of PDP plans need to carefully check their plan’s formulary.  Private insurance companies do change these each year and something that is covered this year may not be next year.  It is possible there is a prescription drug plan that is a better fit for you for next year.
5. If possible, it is a good idea to look at the total cost of this year’s plan (plan premium, deductibles, co-pays and co-insurance) to see if you can save money next year. It is important to think about your budget as well as your healthcare needs.

There are many resources to help you learn more about the Medicare Annual Enrollment 2023:

1. Visit the Medicare.gov website: The official Medicare website provides information about all aspects of  Medicare.
2. State Health Insurance Assistance Programs (SHIPs): SHIPs offer free, personalized Medicare counseling and assistance.  These programs can also provide valuable information on programs for those with a limited income.
3. Medicare and You Handbook: The Medicare and You Handbook is a comprehensive guide to Medicare that is updated each year and mailed to all Medicare beneficiaries.
4. Call a local insurance agent.  Make sure the agent is licensed and appointed to sell the most competitive plans in your area.  If you find a reliable and knowledgeable agent, this will help narrow down the choices for you to make an informed decision.

The Medicare Annual Enrollment 2023 is an important time of year for Medicare beneficiaries to review and make changes to their coverage. By staying informed and considering your health care needs, you can make the best decisions for your health and budget.

Please note;  any changes you make during the Medicare Annual Enrollment period will not take effect until January 1, 2024.

There are other enrollment periods that yo may be able to take advantage of during the year.

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How to avoid Medicare mistakes

If you are getting close to your 65th birthday, you need to know how to avoid Medicare mistakes.  Some mistakes can be difficult to repair and may end up costing you money.

Let’s start by explaining what original Medicare is;  Original Medicare is a health insurance program offered by the federal government.  There are 2  parts to original Medicare.  The first part is Part A.  In general, Part A covers hospital costs.  The second part is Part B.  Part B covers things such as doctor’s visits as well as other outpatient services.  Most providers participate in original Medicare.

Here are some mistakes people make with Medicare:

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 Common Definitions in Medicare and Supplemental Insurance

The jargon around Medicare and insurance in general can feel very inaccessible to potential clients. One of the ways that agents can earn the trust of those clients as well as inform them and help them find coverage that works for them is to know the common definitions in Medicare and Supplemental insurance.

The following are some of the common Medicare-related terms that clients will need to know:

Annual Election Period (AEP):

This is the period of time during which people can enroll in, disenroll from, or change their Medicare Advantage, Supplemental plans or prescription drug plans. This is also the period of time in which beneficiaries can return to original Medicare. Choices made during this time period are effective January 1st of the following year.  The time period is October 15th to December 7th.

Coverage Gap or Donut Hole:

Not every beneficiary will reach this gap. However, the coverage gap for 2023 begins after the beneficiary and their drug plan have spent $4660 dollars on covered and approved medications. While in this coverage gap, members with higher prescription drug costs will  pay a higher percentage of the cost of their medicine.

Deductible:

This is the amount that beneficiaries will pay for benefits before the plan begins to pay for their benefits.  These include medical coverage, including services, prescriptions, and products.

Initial Coverage Election Period:

This is often referred to by its acronym, the ICEP. This is the period of time when a person who is eligible for Medicare can sign up to receive those benefits for the first time. It begins three months before the person’s birthday month, includes the birthday month, and ends three months after the birthday month. It is a seven month period.

Medicaid: It is easy to get confused between Medicare and Medicaid. Medicaid is a program that provides health-coverage for certain low-income people. Most often included are pregnant women, the elderly, and those with disabilities. It is funded jointly by federal and state money.

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Medicare Enrollment Periods 2023

CMS regulates when beneficiaries can change Medicare Advantage and PDP plans.   This article addresses Medicare enrollment, not MAPD/PDP enrollment.

General Enrollment Period 

The General Enrollment Period (GEP) runs from January 1 through March 31. Coverage begins the first of the following month for beneficiaries enrolling  in Medicare during the GEP.  In previous years, coverage did not begin until July 1.

Initial Enrollment Period 

The Initial Enrollment Period (IEP) is the seven-month period.   Medicare beneficiaries can enroll 3 months prior and up to 3 months after their  65^th birthday month.  IEP includes three months before, the month of, and three months after someone’s 65^th birthday month.  Prior to  2023, people who enrolled in Medicare during the last three months of their IEP had to wait up to three months for coverage to begin.   That is no longer the case.   Coverage is effective the first of the month after the month of enrollment.

Special Medicare Enrollment Periods 2023

CMS established Special Enrollment Periods (SEPs) for Part B and premium Part A for those with an exceptional circumstance. SEP allows expand Medicare enrollment opportunities, reduce gaps in coverage, and prevent late enrollment penalties.

ISEP – New to Part B

This election period applies to beneficiaries new to Part B.  Side note:  a MAPD/PDD application must be submitted prior to the Part B effective date in order to use the ISEP.

SEP – Emergency or Disaster

This special election period offers beneficiaries that missed an enrollment opportunity due to a government declared an emergency.   FEMA disasters are an example.  Click here for additional disaster SEP information. 

SEP for  Loss of Coverage 

An individual can use this SEP if their employer, employer plan, or someone acting on behalf of their employer gave them incorrect information that caused them to delay Medicare enrollment.  In addition, this SEP applies when an individual loses group coverage.   CMS allows a full 2 months for enrollment after the loss of creditable coverage.

SEP for Formerly Incarcerated Individuals

This SEP is for individuals who are released from incarceration on or after January 1, 2023.   Formerly incarcerated people may be eligible for a Special Enrollment Period to enroll in Premium Part A and Part B. They won’t have to pay a late enrollment penalty if they enroll using the SEP.

Coverage start date is the first day of the month following the month of enrollment.   Alternately, retroactive coverage can be requested up to 6 months in the past.  Note: retroactive premiums apply.

SEP to Coordinate with Termination of Medicaid Coverage

This SEP, also called the Medicaid SEP, is for people who lose Medicaid eligibility.   CMS allows a change for 3 months from either the day of ineligibility or notification, whichever is longer.

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Sign up for Medicare On Line

It is possible to sign up for Medicare on line. For those of you who are unfamiliar with Medicare, it is a government health insurance program.  Medicare is not only for people age 65 or older,  younger people who qualify as disabled and meet certain criteria may also use it. Signing up for Medicare does not have to be overwhelming.  You can sign up for Medicare on line, from your own computer!

What to know about applying for Medicare –

You have some choices to make when you sign up for Medicare.  When you are eligible, you can sign up for Part A, that’s hospital insurance and it is free. You are also eligible for Part B , that’s medical insurance.  Because you have to pay a premium for Part B coverage, you can decide not to take it. Although, if you change your mind and want to enroll in Part B after your initial enrollment, you could be charged a late enrollment penalty fee for the entire time you have Part B coverage.  The cost of this penalty will raise your coverage cost by 10 percent for every 12-month period you were eligible for Part B, and did not take it.  In some cases,you may avoid the penalty fee if,  you qualify for a special enrollment period.

If you are eligible to join Medicare at age 65, you basically have 6 months to enroll in Medicare.  The enrollment period starts three months before you  turn 65, that period includes the month you turn age 65. The enrollment period ends three months after your 65th birthday. However, if you choose not to enroll in Medicare Part B during your initial enrollment period, you will have the option to choose enrollment later.  Medicare part B offers a general enrollment each year to sign up, it starts on January 1  and ends on March 31. Your coverage go into effect on July 1 of the same year you enroll.

In fact, If you have Medicare you are eligible for Medicare prescription drug coverage.  This coverage does have a cost.   Although,  if you have limited income, you may qualify for help with either all or some of the plan cost.

 Sign up for Medicare on line:  CLICK TO SIGN UP FOR MEDICARE ON LINE

The Social Security administration works with CMS(Centers for Medicaid and Medicare Services) by enrolling people in Medicare.  In fact, CMS is the agency that manages Medicare.

You can apply for Medicare on line, as soon as you are eligible. Click this link to get the online application to sign up for Medicare.  It will only  take a few minutes to complete. Once you complete the on line application and submit it, you’re all set. Normally, there is no documentation needed and there are no forms for you to sign. Once you submit your application, Social Security will process it.  Social Security will only contact you if  they need additional information. Once your application is processed all you have to do is wait for your Medicare card to come in the mail.

To find out what documents and information you need to apply, go to the Checklist For The Online Medicare, Retirement, And Spouses Application.

 Already have Medicare, you can save yourself time and get both information and services online.

If you are a Medicare Part A member and you decide to enroll in Medicare Part B, you can click the link and complete a form CMS 40-B.   This form is an application for Medicare Part B (Medical Insurance). After you fill it out, just mail it to your local Social Security office.

Most people will automatically  be signed up for Part B of Medicare.  If you are getting Social Security payments, you will be signed up prior to you 65th birthday.  When you get the Medicare Card, it will show that Part A and B are in place.  There are instructions on the card if you decide you do not want part B.

If you’re 65 or older and you aren’t getting Social Security or RRB benefits yet (for instance, because you’re still working), you won’t get Part A and Part B automatically. People of any age diagnosed with ESRD and who meet certain requirements are also eligible for Medicare Part A and Part B, but must sign up for them.

You need to sign up by contacting Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. If you worked for a railroad, call your local RRB office or 1-877-772-5772 to learn more about signing up.

CMS cheat sheet part B sign up