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Medicare Advantage: A Strategic Perspective

Precision Targeting for Enrollment Growth

Medicare enrollment recently started and will continue through December 7. During this time, many seniors are making decisions about the quality of their healthcare services. Their decisions will affect what they pay, the doctors they see, and the services they use. While they have a plethora of options, Medicare Advantage is a popular option among seniors. It is also profitable for plan sponsors.

With significant growth in the senior market, the number of 65-plus people is expected to increase 30 percent to 73 million by 2030 and 70 percent to 95 million by 2060. Also, Medicare Advantage enrollment is expected to increase at an even greater rate. Currently, 24.2 million Americans are enrolled in Medicare Advantage. This number is expected to reach 37.5 million Americans in 2030.

The Popularity of Medicare Advantage Among Seniors is Attributed to Five Factors

Results

Outcomes for Medicare Advantage enrollees are equal to or better than traditional fee-for-service enrollee outcomes.

Simplicity

Medicare Advantage can be described as an integrated plan that covers multiple areas. Specifically, it includes Medicare Part A (hospital insurance) and Part B (medical insurance, such as professional and outpatient care), and 90 percent of Medicare Advantage plans cover Part D (prescription drugs).

Scope

Medicare Advantage covers services not offered in traditional Medicare fee-for-service plans. For example, Medicare Advantage can include dental and vision coverage, vision, health supplements, fitness programs, and even transportation for scheduled visits.

Choice

The average Medicare Advantage enrollee has 24 plan options in their community. In nine states already, enrollment is nearing 50 percent penetration.

Cost

Only 40 percent of Medicare Advantage enrollees pay an additional premium. Also, the Centers for Medicare & Medicaid Services (CMS) recently announced that 2021 monthly premiums for Medicare Advantage will decline from an average of $23.63 this year to $21.

Taking a focused approach, driven by data, is key in identifying specific audiences to promote plan incentives and benefits.

As we also consider private insurers, several have a dominant role. They include United Healthcare, Humana, Blue Cross Blue Shield, and Aetna CVS Health For such plan sponsors and others, Medicare Advantage plans tend to offer increased profits. This is likely because incentives for providers, plan sponsors, and enrollees are aligned around accessible, comprehensive, personalized, and cost-effective holistic care.

Targeting for Medicare Advantage Growth

As Medicare Advantage will have increasing enrollment, healthcare organizations may be inclined to pursue sophisticated targeting of locations for senior healthcare and wellness facilities, as well as eligible enrollees as part of their strategic marketing efforts. Doing so requires precision. Demographics and location alone are not enough. Understanding people’s health status, preferences, values, and utilization patterns is necessary to pinpoint target audiences for recruitment and marketing.

Medicare Advantage Attractiveness Index screenshot
Pictured above: Medicare Advantage activeness index developed through ZeroIn™ by ERDMAN Analytics based on attributes of Medicare Advantage populations.
Taking a focused, data-driven approach to understand and identify specific audiences to promote Medicare Advantage incentives and benefits is key. As it relates to Medicare Advantage, ZeroIn by ERDMAN Analytics offers an array of proprietary tools to define market-specific attributes, insights, and options for healthcare services, locations, spaces, and partners. ZeroIn by ERDMAN Analytics can target prospective program enrollees based on their own key market, demographic, financial, and psychographic data. For example, consider the map to the right. It showcases a comprehensive attractiveness index specific to key attributes of Medicare Advantage populations.

Medicare Advantage Facts and Figures

medicare advantage statistic icon

Enrollment in Medicare Advantage plans increased from 6.9 million in 1999 to 24.1 million in 2020…

This represents 36% of all 67.7 million Medicare beneficiaries.

Medicare Advantage enrollment is forecast to increase to 51% in the eligible Medicare population by 2030.

medicare advantage statistic icon
medicare advantage statistic icon

Over 40% of Medicare beneficiaries are enrolled in Medicare Advantage plans in nine states. They include Alabama, Connecticut, Florida, Hawaii, Michigan, Minnesota, Oregon, Pennsylvania, and Wisconsin. Other locations include Puerto Rico and two states with less than 10% enrollment (Alaska and Wyoming). Outside of these areas, 10 states have an enrollment range of 11% to 20%.

Medicare Advantage includes Part A (hospital insurance), Part B (medical insurance), and usually Part D (Medicare drug coverage, plus other services such as fitness and over-the-counter therapies). Nearly 80% of Medicare Advantage enrollees are in plans with quality ratings of four or more stars. This is an increase from 2019. The share of enrollees in plans with three stars, which is an average rating, declined by half from 6% in 2019 to 3% in 2020.

medicare advantage statistic icon
medicare advantage statistic icon

After remaining flat for four years, the total number of Medicare Advantage plans increased by 34% over the past two years to 2,734.

ERDMAN Takeaway

As the senior population is growing, so is the interest in Medicare Advantage programs. To best cater to this trend, health systems need to understand the drivers that make Medicare Advantage an attractive option for the aging population. Factors include results, simplicity, scope, choice, and cost. Additionally, taking a focused approach, driven by data, is key in identifying specific audiences to promote plan incentives and benefits.

If you need guidance on the best next steps to take as part of this year’s Medicare enrollment period, ERDMAN is here for your support. We have decades of experience in healthcare and market research to advance your care models.

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  1. Centers for Medicare & Medicaid Services. (2019, September). Understanding Medicare Advantage Plans [Brochure]. Retrieved from https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf
  2. Fried, C. (2020, August 30). Medicare Advantage has higher incidences of death. Retrieved from https://www.pressreader.com/usa/albany-times-unionsunday/20200830/282196538342286
  3. Figueroa, J. F., Wadhera, R. K., Frakt, A. B., Fonarow, G. C., Heidenreich, P. A., Xu, H., . . . Maddox, K. E. (2020). Quality of Care and Outcomes Among Medicare Advantage vs Fee-for-Service Medicare Patients Hospitalized with Heart Failure. JAMA Cardiology. doi:10.1001/jamacardio.2020.3638
  4. Brady, M. (2020, July 13). Providers, payers hint they will sue CMS over proposed IPPS rule. Retrieved from http://www.modernhealthcare.com/payment/providers-payers-hintthey-will-sue-cms-over-proposed-ipps-rule
  5. Keckley, P. (2019, July 08). Three Reasons Medicare Advantage (MA) is a Viable Framework for America’s Health System: A Strategic Perspective. Retrieved from https://www.paulkeckley.com/the-keckley-report/2019/7/7/three-reasons-medicare-advantage-ma-is-a-viable-framework-for-americas-health-system-a-strategic-perspective-sbhf6
  6. State of Medicare Advantage (pp. 1-17, Rep.). (2020). Washington, D.C.: Better Medicare Alliance.
  7. Freed, M. and Gretchen, J. (2019, December 11). Medicare Advantage 2020 Spotlight: First Look – Data Note. Retrieved from https://www.kff.org/report-section/medicare-advantage-2020-spotlight-first-look-data-note/

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