UnitedHealthcare Medicare Advantage Dominates MA Enrollment 2021

Increased enrollment in for-profit Medicare Advantage plans drove record-high Medicare Advantage enrollment levels in 2021 with UnitedHealthcare Medicare Advantage plans taking the lead, a report from The Chartis Group found.

“The headline-grabber this year is United,” the report stated. “2021 further cemented them as the unrivaled national leader in Medicare Advantage and increased their share 1 percentage point. In 2019 and 2020, they fought for this position with Aetna and Humana, but this year unmistakably outpaced both for membership capture.”

UnitedHealthcare saw the greatest growth among the for-profit health plans, adding 827,000 new lives to the company’s Medicare Advantage plans and comprising 27.37 of the national share in 2021. The payer led the for-profit pack in 2020 as well, with 26.47 percent of the national share of Medicare beneficiaries.

Moreover, UnitedHealthcare snatched up over 36 percent of the net-new enrollees in 2021.

The researchers considered the impact that entering new markets might have on Medicare Advantage plans’ success in securing larger segments of the market share.

“United has successfully doubled or tripled its membership annually in the years following new market entry,” the researchers found.

“Other plans, both national and venture-backed, show similar aptitudes in the years following market entry. Given the plans’ successes this year in expanding new market enrollment so meaningfully, we anticipate their enrollment gains in the next few years to persist and further compound.”

The top four for-profit payers with the largest shares of the Medicare Advantage population stayed the same between 2020 and 2021. Humana followed UnitedHealthcare. Aetna came in third and Anthem was in fourth place with a single-digit market share.

Centene jumped two rankings from seventh place to fifth place. This shift was largely the result of Centene's acquisition of WellCare. The deal added 575,000 Medicare Advantage members to Centene's enrollment.

UnitedHealthcare and Centene together gained 1.6 million new members, boosting their combined share by four points.

Compared to non-profits and Blues plans, for-profit health plans contributed the most to Medicare Advantage membership growth overall. Over 85 percent of the new members were in for-profit health plans. Non-profit health plans added 8.3 percent of the membership growth and Blues plans contributed 6.4 percent.

Kaiser Foundation led the way in the non-profit plan space with 59,000 new enrollees and, among Blues plans, Blue Cross and Blue Shield Louisiana topped the competition, drawing 22,000 new enrollees.

Blue Cross Blue Shield companies are not seeing the same success in the Medicare Advantage market that they have experienced in the Affordable Care Act marketplace. The Blue plans contributed 6.3 percent of enrollment growth in 2021, compared to their 10.6 percent growth in 2020, ceding ground to for-profit health plans.

For-profit health plans also continue to edge out venture-backed plans, although the smaller payers still wield some influence. Although mergers and acquisitions pose a threat to this group, venture-backed health plans continue to make their presence felt by attracting significant amounts of private capital that allow them to build up their membership.

Apart from potential trends related to entering new markets, the report did not explain why UnitedHealth Group saw such strong membership growth.

However, CMS data revealed that four UnitedHealth Group Medicare Advantage plans received five-star ratings from the Medicare Advantage Star Rating program in 2021. That made UnitedHealth Group the for-profit payer with the highest number of five-star plans in the Medicare Advantage space.

For 2021, major for-profit Medicare Advantage payers UnitedHealthcare, Humana, and Cigna—which ranked sixth among for-profit health plans in both 2020 and 2021—focused on reducing out-of-pocket healthcare spending and emphasized home healthcare solutions.