Fewer seniors expected to enroll in Medicare Advantage next year
Enrollment in Medicare Advantage plans is projected to decline for the first time in over a decade, with more seniors opting for original Medicare in 2025. Insurers are scaling back offerings amid rising costs and regulatory pressures. This shift could affect millions of beneficiaries seeking coverage.
Medicare Advantage, the private alternative to traditional Medicare, has seen steady growth since its expansion in the early 2000s, now covering about 30 million people or half of all Medicare beneficiaries. However, for the upcoming enrollment period starting in October 2024 for coverage in 2025, experts anticipate a reversal. "We're expecting a dip in enrollment for the first time in 12 years," said Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF, a health policy research organization.
The primary drivers of this change include insurers' responses to escalating medical costs and new federal regulations. Many plans are exiting certain markets or narrowing their networks to control expenses, reducing options for seniors in rural and suburban areas. For instance, some major insurers like UnitedHealth and Humana have announced they will offer fewer plans in select states. Additionally, the Centers for Medicare & Medicaid Services (CMS) has imposed stricter oversight on prior authorizations and marketing practices, which some providers argue adds administrative burdens.
Seniors may find original Medicare more appealing due to its broader provider access without network restrictions, though it often requires supplemental insurance to cover gaps. "Traditional Medicare gives people more choice in doctors and hospitals," noted David Certner, legislative counsel at AARP. Enrollment in original Medicare is forecasted to rise by around 1.5 million beneficiaries, potentially easing some pressures on the program but raising concerns about affordability without the extra benefits like dental and vision that Advantage plans typically provide.
This trend highlights ongoing debates in U.S. healthcare policy. Proponents of Medicare Advantage praise its value-added perks, while critics point to issues like care denials and upcoding practices that inflate payments to insurers. As the open enrollment period approaches from October 15 to December 7, 2024, advisors urge beneficiaries to review their options carefully amid these changes.