✅ FREE 20-mins Ghost Provider Analysis for MA Networks

Understanding the Medicare Advantage Landscape: A High-Level Overview Payor Parent Organizations

3 min read        August 17, 2023       Article

3 min read
August 17, 2023
Article

The Medicare Advantage (MA) landscape in the United States is sustained by an intricate network of healthcare Providers, Beneficiaries, and Payors. Payors, private health insurance organizations which provide health coverage for MA beneficiaries, cleverly steer the course of care management, wisely balancing the demands of maintaining care quality, managing costs, and maintaining appeal in the market.

This article underscores the fluidity and fierce competition among Payors within the MA market. Despite the fluctuating dynamics, this piece continues to cover the facts on the landscape of Payors with different sub-entities and the positioning of the same in terms of enrollment.

In the Medicare Advantage market, roughly 300 Parent Organizations (POs) are currently providing individual and group Medicare Advantage plans nationwide in 2023, marking a slight decrease from 307 POs in the previous year. Here is a breakdown of the number of POs providing different types of plans:

Note: The following information pertains exclusively to the POs offering individual Medicare Advantage plans.

Within various Parent Organizations, there are sub-entities referred to as Organizational Marketing Channels. Among these, Elevance Health, Inc. (Elevance) stands out with a high count of 23 distinct Marketing Organizations (MOs) under its umbrella. This is followed by Molina Healthcare, which houses 17 such entities.

Trinity and Centene Corporation (Centene) also have a notable presence, each containing 13 MOs. Across all SNP types, Elevance surpasses others with the highest number of subsidiary entities. The sole exception to this is in the I-SNP category, where the PO Mark T. Mitchell takes the lead.

As of June 2023, both individual and group plans cater to approximately 31.6 million beneficiaries, with individual plans alone constituting a substantial 83% of this coverage. This market has been largely dominated by five prominent Payors since 2019: UnitedHealth Group, Inc. (UHG), Humana Inc. (Humana), CVS Health Corporation (CVS), Elevance, and Kaiser Foundation Health Plan, Inc. (KFHP). A steady trio at the top, UHG, Humana, and CVS have unwaveringly held their reign, while the lower ranks have witnessed market share variations year-over-year. These top five Payors hold approximately 67% of the total enrollment market share.

Among the existing POs, 57% witnessed growth over the past year, while a decline was observed in only 20% In the spotlight on this growth, Devoted Health demonstrated the most rapid expansion in a relatively short period. Initially encompassing just 3,039 enrollees during 2019, its current total has skyrocketed to an impressive 130,166 as of 2023.

The table displays the total enrollment, the number of MOs, the market share, and the number of states where POs are present.

Conclusion:

In conclusion, this analysis unveils the intricate Medicare Advantage landscape, spotlighting Payor Parent Organizations. Despite a slight decrease in the number of Payors, dynamic competition persists among approximately 300 POs in 2023. Amid 31.6 million beneficiaries, individual plans claim 83%. Leading Payors – UnitedHealth Group, Humana, CVS, Elevance, and KFHP – continue to exert a dominant presence, collectively commanding 67% of total enrollment.

Notably, Elevance Health stands out with 23 Marketing Organizations, while Devoted Health’s rapid ascent highlights growth potential. These nuanced statistics emphasize the sector’s dynamism, empowering stakeholders to strategically navigate the evolving Medicare Advantage terrain.

Share this insight!

Request A Personalized Demo
Let us show you how HealthWorksAI can optimize your Medicare Advantage product design efforts at every stage through actionable insights by leveraging public and private healthcare data.