MA market dynamics are becoming increasingly frenetic as overall enrollment and plan growth sets records.
The numbers from Medicare Advantage (MA) 2022 open enrollment are in. They offer expected results and a few surprises—some of which have already dominated the headlines. One thing is for sure: MA market dynamics are becoming increasingly frenetic as overall enrollment and plan growth sets records.
Three plans were the top performers compared to overall growth
Based on a comparison of CMS Monthly Enrollment by Plan data (January 2021 and January 2022), three large commercial carriers had the most year-over-year (YOY) growth. Centene; Aetna, a CVS Health company; and UnitedHealth Group grew 29%, 12%, and 11%, respectively—all of which eclipsed YOY overall MA market growth of 8.8%.
Highlights from the leading carriers include Centene's MA entry into three new states, with all three insurers—including UnitedHealth—grabbing enrollment from other plans (largely Humana and Cigna).
A tale of the next three plans
While Anthem and Humana failed to meet their projections, they grew enrollment nonetheless—by 24% and 7%, respectively. Cigna was the only large commercial payer to lose overall enrollment, a disappointment given the company's goal of 10%–15% recurring annual MA growth.
These MA competitors cited different and sometimes disputed factors. "It's been a competitive market. It remains a competitive market," said Anthem CEO Gail Boudreaux. Business Insider reports that Humana and Cigna "blamed heightened competition for older health-insurance customers. In Humana's case, multiple analysts believe the company priced too conservatively. Humana also cited aggressive competitor sales and marketing tactics while stating the company would be reexamining its value proposition.
A record-breaking number of plans in more counties and states
Plan growth tracked with enrollment growth, with a new high of 3,834 MA plans available in 2022 (an 8% increase from 2021).
Geography wasn't the only growth factor
Having a retail footprint was a driver that worked for Aetna, whose acquisition by CVS Health offers unique advantages for MA growth: retail chains with health clinics and pharmacies that offer an alternative site not only for lower-cost primary care but also customer-broker meetings. A reimagining of the sales process, including agent house calls, has been a significant challenge for all health plans during the pandemic.
New MA players identify other reasons, while denying their pricing helped them steal membership from incumbents. Alignment Healthcare, Bright Health, Clover Health, and Devoted Health were the top four MA startups this enrollment season.
The disrupters disrupted on cue, mostly
Devoted and Clover—like Aetna, Centene, and United—grew membership faster than the market and are part of the "flood of competition" traditional plans are facing. Alignment Healthcare also grew its MA membership, 16% according to Business Insider and with 90% of that number gained from established carriers. It is still an area to watch, however. Even with this number, Alignment did not meet its growth projections and there is talk that the MA startup market may be facing a bubble as stock prices for startups-gone-public like Alignment, Cano Health, Clover Health, and Oscar Health have dropped significantly since their IPOs.
Editor's note: This story was updated on February 16, 2022.
“It's been a competitive market. It remains a competitive market.”
— Anthem CEO Gail Boudreaux
Laura Beerman is a contributing writer for HealthLeaders.
KEY TAKEAWAYS
Aetna, Centene, and UnitedHealth Group were among the Medicare Advantage leaders.
Humana and Anthem did not meet projections but still grew, while Cigna lost members.
Plan volume and geographic expansion provided organic growth with pricing and competition factoring into incumbent and startup disruption alike.