Medicare Advantage enrollment surpasses 30 million

Nearly half of all Medicare beneficiaries are enrolled in Medicare Advantage programs. Insurers hailed the milestone, but lawmakers have pressed for reforms, citing delays in approval for treatments.

Medicare Advantage programs have been surging in popularity in recent years, and new federal data reveals a significant enrollment milestone.

More than 30 million Americans are now enrolled in Medicare Advantage programs, according to new data released Tuesday by the Centers for Medicare & Medicaid Services. A year ago, 28 million people were participating in some type of Medicare Advantage plans, according to the Kaiser Family Foundation.

Payers say the plans protect consumers from substantial out-of-pocket costs they would incur under Medicare.

Matt Eyles, president and CEO of America's Health Insurance Plans, said Tuesday that enrollment topping 30 million represents “a huge endorsement of the value of this program.”

“This milestone shows that people are choosing MA for better affordability and health outcomes,” Eyles said in a statement. “The continued growth of the program is a testament to the tremendous value MA offers to all enrollees, and especially those with chronic illnesses who require care coordination and management, as well as those with low incomes who rely on MA’s access to additional benefits at little or no cost.”

Medicare Advantage programs have grown rapidly. Ten years ago, about 13 million Americans were enrolled in MA programs, according to the Kaiser Family Foundation.

Analysts expect Medicare Advantage programs to gain more consumers. KPMG projected that more than half of all Medicare beneficiaries could be enrolled in Medicare Advantage plans by the end of 2023. Trella Health also identified the growth of Medicare Advantage as one of the top trends in post-acute care.

Still, some lawmakers have criticized Medicare Advantage plans for hassles doctors are encountering getting prior authorization for treatment.

The House of Representatives passed a bill in September to revamp the prior authorization process in Medicare Advantage plans. The bill would have required Medicare Advantage plans to tell the Centers for Medicare & Medicaid Services how often they are using prior authorization and the rate of approvals and denials. It also would have established an electronic prior authorization process.

“We must deliver a quality product that allows providers to keep our seniors as healthy as possible, while reducing wait times, paperwork and hassle,” U.S. Rep. Suzan DelBene, D-Wash., the sponsor of the bill,  said on the House floor in September. “Unfortunately, the cumbersome and antiquated prior authorization process that many Medicare Advantage plans utilize often gets in the way.”

The measure had strong support in the Senate and healthcare organizations, including the American Medical Association. But the legislation wasn’t included in the massive $1.7 trillion spending package Congress finalized in late December. With a new Congress seated earlier this month, lawmakers pushing the measure will have to begin the legislative process all over again.

Doctors, medical groups and hospitals say the prior authorization process hinders patients from getting treatments and leads to negative health outcomes. Payers contend the authorization process is essential to curb wasteful spending and prevent unnecessary treatments.

Medicare Advantage plans enable consumers to obtain benefits beyond traditional Medicare, including more comprehensive prescription drug coverage, vision, dental and home healthcare services, AHIP says.

“Medicare Advantage is a model of public-private partnerships that improve affordability, access, benefits, and satisfaction for patients, consumers, and taxpayers,” Eyles said.