Medicare Advantage Opportunities by MSAs Still Exist

October 10,2023

There are 32.4 million people enrolled in Medicare Advantage (MA) products nationwide, representing 49% of the 65.9 million Americans eligible for Medicare. Within Metropolitan Statistical Areas (MSAs) nationwide, where 93% of Medicare Eligible people reside, most individual Medicare beneficiaries have two or more, often many more, MA health insurance carrier options to choose from, as of September 1, 2023. Market share at the county and MSA level is available and often analyzed to gain a more nuanced competitive picture of specific markets. In this brief, Mark Farrah Associates (MFA) presents a summary of Medicare and MA market enrollment figures by MSAs, included in Health Coverage Portal™ and Medicare Business Online™.

As the number of Medicare beneficiaries increases, health plans are looking to expand in new and under-penetrated markets. Companies also evaluate their own market positions against competitors to assess ongoing relative market opportunity. MFA analyzed Medicare and Medicare Advantage market enrollment figures by MSAs and found six MSAs with over a million people eligible for Medicare. As shown below, original Medicare and MA penetration rates vary across the six largest MSAs.

• Miami continues to have the highest penetration rate of the top six MSAs in the MA market at 63.9%, up from 62.7% last year, and the lowest original Medicare penetration rate at 37.7%.
   
• Los Angeles also had an above average MA rate at 55.2%.
   
• The Chicago MSA had the highest original Medicare rate among the top six MSAs, at 60.3%, and the lowest MA penetration rate of 40.1%.
   
• MA penetration rates increased across all the top MSAs in the nation, between 2022 and 2023, including Chicago.

MFA also noted, as of September 1, 2023, that there are 20 MSAs, out of 935, with only one carrier serving individual MA members. Thirty-seven MSAs have two carriers, typically Humana and UnitedHealth Group, the top two MA carriers nationwide. More than 878 MSAs offer 3 or more carriers to choose from, an increase over the 850 MSAs in 2022; and 42 MSAs have ten or more choices, up from 37 last year.

For the MSAs with only one carrier serving individual MA members, the top six based on Medicare Eligibles are shown below:

• Of the 20 MSAs with only one carrier to choose from, 5 offered their first MA carrier in 2023; and 7 MSAs have had a single carrier since 2019. The single carriers in 7 other MSAs entered the market after 2020. In Casper, WY, a second carrier entered the market 2021, but either exited the market in 2022 or has de minimis (under 10) enrollment in 2023.
   
• Anchorage, Alaska is, once again, the largest MSA with only one carrier serving the MA Individual marketplace. Based on CMS Landscape files for 2024, that carrier, Zing Health Enterprises Group (also known as Lasso Healthcare Insurance Company), is withdrawing from the MSA in 2024. While other carriers offer coverage in the Group MA market in Anchorage, Zing Health was the only carrier offering MA products directly to individuals in 2022 and 2023.
   
• UnitedHealth is the sole carrier offering MA products directly to individuals in 9 MSAs; Humana is the sole carrier for individuals in 6 MSAs.
   
• Four of the Top Six MSA from last year’s Business Strategy report, Medicare Advantage Opportunities by MSAs, added additional carriers in 2023.

Based on September 1, 2023 MA enrollment from the Centers for Medicaid and Medicare Services (CMS), as presented in MFA’s Health Coverage Portal™ and Medicare Business Online™ products, MFA found a significant choice of MA carriers for Individuals seeking alternatives to traditional Medicare and Medicare Advantage options, for most MSAs nationwide.

About Mark Farrah Associates (MFA)

Mark Farrah Associates (MFA) is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry. Our product portfolio includes Health Coverage Portal™, County Health Coverage™, Medicare Business Online™, Medicare Benefits Analyzer™, 5500 Employer Health ^PLUS, and Health Plans USA™. For more information about these products, refer to the informational videos and brochures, available under the Our Products section of the website (www.markfarrah.com) or call 724-338-4100.

Healthcare Business Strategy is a FREE monthly brief that presents analysis of important issues and developments affecting healthcare business today. If you would like to be added to our email distribution list, please submit your email address to the "Subscribe to MFA Briefs" section at the bottom of this page. Mark Farrah Associates will continue to analyze and report on important health insurance segment performance and related topics. Stay tuned for future analysis briefs with valuable insights about the health care industry.