A key objective of the Medicare Benefit program was to advertise competitors to enhance well being advantages and decrease prices for seniors. Nonetheless, a brand new report from KFF reveals that this is probably not occurring.
The report revealed Monday discovered that in 2024, 79% of counties within the U.S. had been extremely concentrated for Medicare Benefit, and 18% had been very extremely concentrated.
As well as, 89% of Medicare Benefit enrollees had been in a extremely concentrated market, and 4% had been in a really extremely concentrated market in 2024. About 90% of Medicare beneficiaries lived in a county the place a minimum of half of Medicare Benefit enrollees had been in plans sponsored by one or two insurers.
“Greater market focus in Medicare Benefit insurance coverage markets might decrease the inducement for insurers to compete for potential enrollees by planning extra interesting by means of extra complete advantages or decrease prices,” the researchers mentioned.
For the evaluation, KFF examined publicly out there, county-level Medicare Benefit plan data and enrollment information for all 50 states, in addition to Washington D.C. and Puerto Rico.
KFF additionally discovered that rural counties had extra concentrated Medicare Benefit markets. In 2024, about 39% of essentially the most rural counties had been very extremely concentrated, in comparison with 6% of city counties.
As well as, UnitedHealthcare or Humana was the biggest Medicare Benefit insurer in additional than half of the counties in 2024. UnitedHealthcare was the biggest Medicare Benefit insurer in 41% of counties in 2024, whereas Humana was the biggest Medicare Benefit insurer in 25% of all counties. Blue Cross Blue Defend plans, in the meantime, had been the biggest in 11% of counties, adopted by CVS Well being (8% of counties) and Elevance Well being (4% of counties).
UnitedHealthcare and Humana have lengthy been the 2 largest insurers within the Medicare Benefit market, and collectively, they accounted for practically 47% of complete enrollment nationwide in 2024.
The researchers famous that though the Medicare Benefit market has grow to be very concentrated, this has not been a current focus for policymakers or regulators.
“The latest exercise on the federal stage occurred in 2017 when the Division of Justice blocked a merger between insurers Aetna and Humana, arguing if it went by means of it will considerably elevate market focus within the Medicare Benefit market,” KFF mentioned within the report. “Extra just lately, the dialog relating to competitors in well being care has revolved round elevated consolidation in supplier markets, particularly hospitals and well being programs.”
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