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10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Provision

10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Provision

Note: This brief was updated April 5, 2023, to include more recent and additional data.

  1. Medicaid enrollment has increased since the start of the pandemic, primarily due to the continuous enrollment provision.
  2. KFF estimates that between 5 million and 14 million people will lose Medicaid coverage during the unwinding of the continuous enrollment provision.
  3. The Medicaid continuous enrollment provision has stopped “churn” among Medicaid enrollees.
  4. States have developed plans for how they will approach the unwinding of the continuous enrollment provision.
  5. Maximizing streamlined renewal processes can promote continuity of coverage as states begin to unwind the continuous enrollment provision.
  6. States can obtain temporary waivers to pursue strategies to support their unwinding plans.
  7. Certain groups may be at greater risk for losing Medicaid coverage during the unwinding period.
  8. States can partner with MCOs, community health centers, and other partners to conduct outreach.
  9. Timely data on disenrollments and other metrics will be useful for monitoring how the unwinding is proceeding.
  10. The number of people without health insurance could increase if people who lose Medicaid coverage are unable to transition to other coverage.

At the start of the pandemic, Congress enacted the Families First Coronavirus Response Act (FFCRA), which included a requirement that Medicaid programs keep people continuously enrolled through the end of the COVID-19 public health emergency (PHE), in exchange for enhanced federal funding. As part of the Consolidated Appropriations Act, 2023, signed into law on December 29, 2022, Congress delinked the continuous enrollment provision from the PHE, ending continuous enrollment on March 31, 2023. The CAA also phases down the enhanced federal Medicaid matching funds through December 2023. Primarily due to the continuous enrollment provision, Medicaid enrollment has grown substantially compared to before the pandemic and the uninsured rate has dropped. But, as states resume disenrollments following the end of the continuous enrollment provision, millions of people could lose coverage and that could reverse recent gains in coverage. States can resume disenrollments beginning in April but must meet certain requirements to be eligible for enhanced federal funding during the unwinding.

This brief describes 10 key points about the unwinding of the Medicaid continuous enrollment provision, highlighting data and analyses that can inform the unwinding process as well as legislation and guidance issued by the Centers for Medicare and Medicaid Services (CMS) that lay out the rules states must follow during the unwinding period and the flexibilities available to them.

1. Medicaid enrollment has increased since the start of the pandemic, primarily due to the continuous enrollment provision.

KFF estimates that enrollment in Medicaid/CHIP will have grown by 23.3 million to nearly 95 million from February 2020 to the end of March 2023 when the continuous enrollment provision ended (Figure 1). Overall enrollment increases reflect economic conditions related to the pandemic, the adoption of the Medicaid expansion under the Affordable Care Act in several states (NE, MO, OK), as well as the continuous enrollment provision included in the FFCRA. This provision requires states to provide continuous coverage for Medicaid enrollees in order to receive enhanced federal funding. By preventing states from disenrolling people from coverage, the continuous enrollment provision has helped to preserve coverage during the pandemic. It also increased state spending for Medicaid, though KFF has estimated that the enhanced federal funding from a 6.2 percentage point increase in the federal match rate (FMAP) exceeded the higher state costs through 2022.

The Consolidated Appropriations Act, 2023 decouples the Medicaid continuous enrollment provision from the PHE and terminates this provision on March 31, 2023. Starting April 1, 2023, states can resume Medicaid disenrollments. States will be eligible for the phase-down of the enhanced FMAP (6.2 percentage points through March 2023; 5 percentage points through June 2023; 2.5 percentage points through September 2023 and 1.5 percentage points through December 2023) if they comply with certain rules. They cannot restrict eligibility standards, methodologies, and procedures and cannot increase premiums as required in FFCRA. Further, states must also comply with federal rules about conducting renewals. Lastly, states are required to maintain up to date contact information and attempt to contact enrollees prior to disenrollment when mail is returned.

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2. KFF estimates that between 5 million and 14 million people will lose Medicaid coverage during the unwinding of the continuous enrollment provision.

While the number of Medicaid enrollees who may be disenrolled during the unwinding period is highly uncertain, KFF estimates that between 5.3 million and 14.2 million people will lose Medicaid coverage during the 12-month unwinding period reflecting a 5{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} and 13{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} decline in enrollment (Figure 2). These projected coverage losses are consistent with, though a bit lower than, estimates from the Department of Health and Human Services (HHS) suggesting that as many as 15 million people will be disenrolled, including 6.8 million who will likely still be eligible. While the share of individuals disenrolled across states will vary due to differences in how states prioritize renewals, it is expected that the groups that experienced the most growth due to the continuous enrollment provision—ACA expansion adults, other adults, and children—will experience the largest enrollment declines. Efforts to conduct outreach, education and provide enrollment assistance can help ensure that those who remain eligible for Medicaid are able to retain coverage and those who are no longer eligible can transition to other sources of coverage.

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3. The Medicaid continuous enrollment provision has stopped “churn” among Medicaid enrollees.

The temporary loss of Medicaid coverage in which enrollees disenroll and then re-enroll within a short period of time, often referred to as “churn,” occurs for a several reasons. Enrollees may experience short-term changes in income or circumstances that make them temporarily ineligible. Alternatively, some people who remain eligible may face barriers to maintaining coverage due to renewal processes and periodic eligibility checks. Eligible individuals are at risk for losing coverage if they do not receive or understand notices or forms requesting additional information to verify eligibility or do not respond to requests within required timeframes. Churn can result in access barriers as well as additional administrative costs. Estimates indicate that among full-benefit beneficiaries enrolled at any point in 2018, 10.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} had a gap in coverage of less than a year (Figure 3). About 4.2{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} were disenrolled and then re-enrolled within three months and 6.9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} within six months. Another analysis examining a cohort of children newly enrolled in Medicaid in July 2017 found that churn rates more than doubled following annual renewal, signaling that many eligible children lose coverage at renewal. By halting disenrollment during the PHE, the continuous enrollment provision has also halted this churning among Medicaid enrollees.

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4. States have developed plans for how they will approach the unwinding of the continuous enrollment provision.

CMS requires states to develop operational plans for how they will approach the unwinding process. These plans must describe how the state will prioritize renewals, how long the state plans to take to complete the renewals as well as the processes and strategies the state is considering or has adopted to reduce inappropriate coverage loss during the unwinding period. An Informational Bulletin (CIB) posted on January 5, 2023 included timelines for states to submit a renewal redistribution plan.

According to a KFF survey conducted in January 2023, states have taken a variety of steps to prepare for the end of the continuous enrollment provision (Figure 4).  Under CMS guidance, states had the option to start the unwinding period by initiating the first batch of renewals in February, March, or April. Eight states started the process in February, another 15 started in March, and 28 states began in April. Most states (43) said they plan to take 12-14 months to complete all renewals (the remaining eight states said they planned to take less than 12 months to complete renewals). All states indicated they had taken steps to update enrollee contact information during the past year and nearly three-quarters of states (37) were planning to follow up with enrollees before terminating coverage. As of March 13, 2023, 26 states had posted their renewal redistribution plan, which had to be submitted to CMS by February 15, 2023 for most states. How states approach the unwinding process will have implications for the ability of eligible individuals to retain coverage and those who are no longer eligible to transition to other coverage. Outcomes will differ across states as they make different choices and face challenges balancing workforce capacity, fiscal pressures, and the volume of work.

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5. Maximizing streamlined renewal processes can promote continuity of coverage as states begin to unwind the continuous enrollment provision.

Under the ACA, states must seek to complete administrative (or “ex parte”) renewals by verifying ongoing eligibility through available data sources, such as state wage databases, before sending a renewal form or requesting documentation from an enrollee. Some states suspended renewals as they implemented the continuous enrollment provision and made other COVID-related adjustments to operations. Completing renewals by checking electronic data sources to verify ongoing eligibility reduces the burden on enrollees to maintain coverage. While 30 states have taken action in the past year to increase ex parte renewal rates, in many states, the share of renewals completed on an ex parte basis is low. Of the 43 states processing ex parte renewals for MAGI groups (people whose eligibility is based on modified adjusted gross income), 18 states report completing 50{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} or more of renewals using ex parte processes. Twenty states complete less than 50{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of renewals on an ex parte basis, including 11 states where less than 25{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of renewals are completed using ex parte processes (Figure 5). The number of states reporting they complete more than 50{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of renewals using ex parte processes for non-MAGI groups (people whose eligibility is based on being over age 65 or having a disability) is even lower at 6.

As states begin to unwind the continuous enrollment provision, there are opportunities to promote continuity of coverage among enrollees who remain eligible by increasing the share of renewals completed using ex parte processes and taking other steps to streamline renewal processes (which will also tend to increase enrollment and spending). CMS guidance notes that states can increase the share of ex parte renewals they complete without having to follow up with the enrollee by expanding the data sources they use to verify ongoing eligibility. However, when states do need to follow up with enrollees to obtain additional information to confirm ongoing eligibility, they can facilitate receipt of that information by allowing enrollees to submit information by mail, in person, over the phone, and online. While nearly all states accept information in-person (51 states) and by mail (50 states), slightly fewer provide options for individuals to submit information online (48 states) or over the phone (46 states).

A proposed rule, released on September 7, 2022, seeks to streamline enrollment and renewal processes in the future by applying the same rules for MAGI and non-MAGI populations, including limiting renewals to once per year, prohibiting in-person interviews and requiring the use of prepopulated renewal forms. Overall, every state has taken at least one action to align renewal processes for non-MAGI populations with those for MAGI populations, including 45 states that have eliminated in-person interviews, 42 states that limit renewals to once per year, and 33 states that send pre-populated renewal forms.
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6. States can obtain temporary waivers to pursue strategies to support their unwinding plans.

As states prepare to complete redeterminations for all Medicaid enrollees, many may face significant operational challenges related to staffing shortages and outdated systems. To reduce the administrative burden on states, CMS announced the availability of temporary waivers through Section 1902(e)(14)(A) of the Social Security Act. These waivers will be available on a time-limited basis and will enable states to facilitate the renewal process for certain enrollees with the goal minimizing procedural terminations. As of February 24, 2023, CMS had approved a total of 163 waivers for 43 states (Figure 6). These waivers include strategies allowing states to: renew enrollee coverage based on SNAP and/or TANF eligibility; allow for ex parte renewals of individuals with zero income verified within the past 12 months; allow for renewals of individuals whose assets cannot be verified through the asset verification system (AVS); partner with managed care organizations (MCOs), enrollment brokers, or use the National Change of Address (NCOA) database or US postal service (USPS) returned mail to update enrollee contact information; extend automatic enrollment in MCO plans up to 120 days; and extend the timeframe for fair hearing requests.

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7. Certain groups may be at greater risk for losing Medicaid coverage during the unwinding period.

As states resume redeterminations and disenrollments, certain individuals, including people who have moved, immigrants and people with limited English proficiency (LEP), and people with disabilities, will be at increased risk of losing Medicaid coverage or experiencing a gap in coverage due to barriers completing the renewal process, even if they remain eligible for coverage. Enrollees who have moved may not receive important renewal and other notices, especially if they have not updated their contact information with the state Medicaid agency. In 2020, one in ten Medicaid enrollees moved in-state and while shares of Medicaid enrollees moving within a state has trended downward in recent years, those trends could have changed in 2021 and 2022.

A recent analysis of churn rates among children found that while churn rates increased among children of all racial and ethnic groups, the increase was largest for Hispanic children, suggesting they face greater barriers to maintaining coverage. Additionally, people with LEP and people with disabilities are more likely to encounter challenges due to language and other barriers accessing information in needed formats. An analysis of state Medicaid websites found that while a majority of states translate their online application landing page or PDF application into other languages, most only provide Spanish translations (Figure 7). That same analysis revealed that a majority of states provide general information about reasonable modifications and teletypewriter (TTY) numbers on or within one click of their homepage or online application landing page (Figure 8), but fewer states provide information on how to access applications in large print or Braille or how to access American Sign Language interpreters.

CMS guidance about the unwinding of the continuous enrollment provision stresses the importance of conducting outreach to enrollees to update contact information and provides strategies for partnering with other organizations to increase the likelihood that enrollee addresses and phone numbers are up to date. CMS guidance also outlines specific steps states can take, including ensuring accessibility of forms and notices for people with LEP and people with disabilities and reviewing communications strategies to ensure accessibility of information. Ensuring accessibility of information, forms, and assistance will be key for preventing coverage losses and gaps among these individuals.
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8. States can partner with MCOs, community health centers, and other partners to conduct outreach.

States can collaborate with health plans and community organizations to conduct outreach to enrollees about the need to complete their annual renewal during the unwinding period. CMS has issued specific guidance allowing states to permit MCOs to update enrollee contact information and facilitate continued enrollment. According to a survey of non-profit, safety net health plans that participate in Medicaid, a majority of responding MCOs reported that they are sending updated member contact information to their state. Additionally, nearly two-thirds of states (33) are planning to send MCOs advance lists of members for whom the state is initiating the renewal process and about half will send lists of members who have not submitted renewal forms and are at risk of losing coverage or who have been disenrolled indicating whether the member was determined no longer eligible or disenrolled for paperwork reasons (Figure 9).

States can also work with community health centers, navigators and other assister programs, and community-based organizations to provide information to enrollees and assist them with updating contact information, completing the Medicaid renewal process, and transitioning to other coverage if they are no longer eligible. A survey of health centers conducted in late 2021 found that nearly 50{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of responding health centers reported they have or plan to reach out to their Medicaid patients with reminders to renew their coverage and to schedule appointments to assist them with renewing coverage. Similarly, a survey of Marketplace assister programs found that assister programs were planning a variety of outreach efforts, such as public education events and targeted outreach in low-income communities, to raise consumer awareness about the end of the continuous enrollment provision. Additionally, nearly six in ten assister programs said they had proactively reached out to their state to explore ways to help consumers; supported the state sharing contact information with them on individuals who need to renew their Medicaid coverage; and were planning to recontact Medicaid clients to update their contact information.
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9. Timely data on disenrollments and other metrics will be useful for monitoring how the unwinding is proceeding.

On January 5, 2023, CMS released an Informational Bulletin that included timelines for states to submit a renewal redistribution plan (discussed above), system readiness plans and results, and baseline unwinding data based on when states plan to begin renewals. These reporting requirements were part of a broad set of CMS guidance documents issued over the past several months. For system readiness reporting, states are required to demonstrate that their eligibility systems for processing renewals are functioning correctly, particularly since states have not been conducting normal renewals while the continuous enrollment provision has been in effect. For enrollment reporting, states will provide baseline data at the start of the unwinding period related to applications, enrollment, estimated timeframe for completing initiated renewals, and fair hearings, and then states will submit monthly reports that will be used to monitor these metrics throughout the unwinding period (Figure 10). The recent CIB notes that CMS is expected to issue guidance to address how new reporting requirements (discussed below) may intersect with the requirements described in prior CMS guidance.

The recently enacted Consolidated Appropriations Act includes additional reporting requirements for states and imposes penalties in the form of reduced federal matching payments for states that do not comply. These enhanced reporting metrics require states to report the total number of individuals renewed and those renewed on an ex parte basis, break out Medicaid terminations for children’s coverage and pregnancy-related coverage, report the number of individuals whose coverage was terminated for procedural reasons, including breakouts for children’s coverage and pregnancy-related coverage, and report total call center volume, average wait time, and average abandonment rate. States are also required to report on transitions to separate CHIP programs and to Marketplace or Basic Health Program coverage (Figure 10). Importantly, the legislation requires that CMS make these reports publicly available. Nearly half of states (24) indicated they plan to publish some unwinding data on their websites, while 21 states had not yet made a decision about posting the data. States that fail to comply with these reporting requirements face a reduction in federal medical assistance percentage (FMAP) of up to one percentage point for the quarter in which the requirements are not met. If CMS determines a state is out of compliance with any applicable redetermination and reporting requirements, it can require the state to submit a corrective action plan and can require the state to suspend all or some terminations due to procedural reasons until the state takes appropriate corrective action.

Collectively, these metrics are designed to demonstrate states’ progress towards restoring timely application processing and initiating and completing renewals of eligibility for all Medicaid and CHIP enrollees and can assist with monitoring the unwinding process to identify problems as they occur. However, while the new data reporting requirements are useful, they will not provide a complete picture of how the unwinding is proceeding and whether certain groups face barriers to maintaining coverage. To fully assess the impact of the unwinding will require broader outcome measures, such as continuity of coverage across Medicaid, CHIP, Marketplace, and employer coverage, gaps in coverage over time, and increases in the number of the uninsured, data that will not be available in the short-term.

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10. The number of people without health insurance could increase if people who lose Medicaid coverage are unable to transition to other coverage.

The share of people who lack health insurance coverage dropped to 8.6{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in 2021, matching the historic low in 2016, largely because of increases in Medicaid coverage, and to a lesser extent, increases in Marketplace coverage. However, as states resume Medicaid disenrollments, these coverage gains could be reversed. CMS guidance provides a roadmap for states to streamline processes and implement other strategies to reduce the number of people who lose coverage even though they remain eligible. However, there will also be current enrollees who are determined to be no longer be eligible for Medicaid, but who may be eligible for ACA marketplace or other coverage. A MACPAC analysis examined coverage transitions for adults and children who were disenrolled from Medicaid or separate CHIP (S-CHIP) and found that very few adults or children transitioned to federal Marketplace coverage, only 21{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of children transitioned from Medicaid to S-CHIP, while 47{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of children transitioned from S-CHIP to Medicaid (Figure 11).

A KFF analysis revealed that among people disenrolling from Medicaid, roughly two-thirds (65{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) had a period of uninsurance in the year following disenrollment and only 26{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} enrolled in another source of coverage for the full year following disenrollment (Figure 12). Together, these findings suggest that individuals face barriers moving from Medicaid to other coverage programs, including S-CHIP. Simplifying those transitions to reduce the barriers people face could help ensure people who are no longer eligible for Medicaid do not become uninsured. Importantly, these findings also show that large shares of enrollees (41{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in the KFF analysis) reenroll in Medicaid after a period of time, and many after a period of uninsurance. Reducing the number of people who lose coverage for procedural reasons even though they remain eligible can also help to reduce the number of people who become uninsured.

The  proposed eligibility and enrollment rule aims to smooth transitions between Medicaid and CHIP by requiring the programs to accept eligibility determinations from the other program, to develop procedures for electronically transferring account information, and to provide combined notices. States can also consider sharing information on consumers losing Medicaid who may be eligible for Marketplace coverage with Marketplace assister programs; however, in a 2022 survey, few assister programs (29{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) expected states to provide this information although nearly half were unsure of their state’s plans.
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Yakima area schools expand online offerings as higher enrollment numbers stick | Education

Yakima area schools expand online offerings as higher enrollment numbers stick | Education

For online pupils, a classroom can be any place. For Yakima On the net junior Claudia Ornelas, Le Mercantile café downtown serves as a morning review corridor exactly where she can sit, sip her drink and do the job by way of geometry issues.

3 decades into the pandemic, lots of factors of daily life have moved on the web, from functioning from house to telehealth appointments. Schools have followed accommodate. However remote discovering was a challenging transition for many students, some uncovered on-line education labored very well for them.

Most of the Yakima County faculty districts that provide on the internet education choices observed an raise in learners right after the pandemic commenced. Some expanded their on line alternatives to contain youthful students intrigued in digital classes.

Educators and students stated a lot of the attractiveness of on-line schooling arrived from its versatility. Pupils can go at their very own pace and seek out aid for their specific struggles. Local administrators said they foresee digital packages increasing even more to fulfill students’ wants.

“I feel the only limitation that we have is our creativeness,” explained Jacob Davis, principal at the reasonably new Yakima K-8 Virtual College in the Yakima School District.

On-line lessons

Regional school districts made available virtual solutions for students prior to the pandemic. West Valley Digital Academy coordinator Ashley Lieberknecht stated the district developed its on line program around 2015 following some college students began to depart for districts that available digital lessons.

Now, some districts like West Valley and Wapato have their individual virtual courses open up to out-of-district pupils.

Districts generally companion with a virtual schooling provider, which handles the curriculum. Learners work with on the net lecturers, who are necessary to have Washington point out instructing licenses.

The curriculum and class plan can vary student to university student. Counselors and coordinators get the job done with students to be certain that they are taking lessons that satisfy their graduation requirements.

Students enrolled in Yakima On-line, which serves Yakima Faculty District higher schoolers, choose just one study course at a time, finishing each and every in about 3 weeks, stated Yakima On line Principal Lois Menard. For younger college students, many core subjects could be covered at the moment, as is the case at Yakima K-8 Virtual Academy, Davis claimed.

Some students get a hybrid tactic, Lieberknecht mentioned. They may get classes on campus in the course of portion of the day and consider online courses only for specific subjects. This choice is specifically well-known with out-of-district learners whose colleges may well not offer you particular subjects, like sophisticated math classes.

Even though these courses differ in some means, normally they are self-paced.

The point out necessitates pupils to spend a specified amount of money of time per week on classwork and every single course. But students are absolutely free to finish that function every time they want. That could be in between other courses, right before operate, immediately after aiding with familial tasks or even exterior the country, Davis reported.

“You’re conversing about a program that matches the pupil and family’s requires,” Davis reported. “It accommodates it.”

To thrive in these kinds of classes, pupils need to have to have strong time administration expertise and moms and dads need to be willing to take a additional active function in their child’s education and learning, Lieberknecht explained. As opposed to in a standard class, there is no trainer to prod college students to do their perform.

“It’s tricky, and I anxiety to the learners and the mothers and fathers that they need to have to be proactive,” she claimed.

Virtual college students have assets to reach out to if they need to have assist. On the internet lecturers are out there through these programs. Some districts provide in-particular person tutoring. On the net students also look at in often with district lecturers to make confident they are being on top rated of their study course hundreds.

College students also have access to aid personnel like counselors, graduation professionals and migrant family members advocates.

“All of our on the internet learners have accessibility to almost everything our in-particular person college students have accessibility to,” claimed Wapato College District on line discovering coordinator Allyson Vinson. She oversees Wapato On the net Academy.

Enlargement of systems

Some local districts observed an enhance in enrollment in virtual applications in 2020 and 2021, even though it normally leveled out this school yr, in accordance to enrollment data from the Place of work of Superintendent of General public Instruction. Lieberknecht said West Valley’s online enrollment has doubled since the pandemic, with about 450 learners enrolled in at the very least 1 on the net class this faculty yr. That figure involves out-of-district learners.

YSD has about triple the range of college students, Menard claimed. In the 2019-20 college yr there were being 99 college student enrolled. This college 12 months, that quantity ballooned to 297, in accordance to OSPI data.

In some districts, the enrollment increases in on-line education led to a lot more solutions. YSD has made available on the internet lessons for older college students for numerous a long time but opened up options for elementary college students this college yr, Menard claimed. In Wapato’s circumstance, the pandemic stirred up curiosity in virtual education possibilities, which led the district to open Wapato On-line Academy in 2021.

“The pandemic prompted it, I would say,” Vinson said. “A great deal of households continue to desired to continue being at residence, and Wapato preferred to give them the option to go on their education and learning although getting house.”

Educators from Wapato and Yakima mentioned that enrollment in the elementary grades is not as significant as the higher grades yet.

The pandemic gave several students their to start with flavor of distant finding out. But contrary to courses that experienced to swiftly switch to on the internet all through the pandemic, virtual systems characteristic classes that had been developed to be shipped via a laptop screen. Also these lessons are normally asynchronous, so students can perform independently, relatively than likely at a rate set by the teacher.

Quite a few districts also turned one-to-one districts as a consequence of the pandemic, in which each and every youngster has accessibility to a university-issued laptop and occasionally Wi-Fi hotspots.

Learners indication up for on line courses for a assortment of factors. The overall flexibility of the class schedule is a huge draw, Davis explained. YSD On the internet also has a sturdy relationship with the district’s Open up Doors method, which will help pupils who are at possibility of not completing higher college obtain their diplomas or GEDs. The software is open up to pupils up to age 21.

Davis mentioned that educators are significantly informed that the “one-size fits all model” does not operate for education. Pupils have different wants. Some may well need much more flexibility or perform much better by on their own, which the virtual education design supports.

“To be able to provide solutions where youngsters get to pick what operates best for them, it is really just growing the probability of that student’s achievements,” he mentioned.

Regional educators associated in on the internet schooling mentioned they be expecting continued progress. Menard pointed out that school students can get master’s degrees online and some firms now have their staff perform remotely whole time. Colleges just followed go well with.

Students target on flexibility

When higher school college student Fatima Sanchez observed out she was expecting, she essential a university schedule that could accommodate her modify in conditions. She had heard that on the web lessons had been fewer nerve-racking. She and her mom talked it over in the course of some of their late-evening drives jointly and Sanchez enrolled in Yakima On the web for her junior year.

6 months in and she stated she located it to be a fantastic in shape. She labored to get in advance on lessons right before her April owing day and felt it was easy to access help from on line tutors when she wanted it.

“You’re able to go at your have rate in its place of stressing and do the job piling up,” she said.

Sanchez reported she plans to return to in-man or woman lessons for her senior calendar year so she can participate in the graduation ceremony. But on-line classes worked so well for her that she in some cases goes back and forth on that final decision.

Fellow Yakima Online junior Claudia Ornelas will graduate at the conclude of this school yr following she began using on line lessons past spring. She also reported she liked obtaining to function at her have pace.

When her eldest daughter expressed desire in switching to on-line courses, Gabriela Ornelas was concerned if would have an impact on her social techniques. But Claudia also requires cosmetology courses at YV-Tech, wherever she manufactured good friends.

Gabriela Ornelas stated she is really happy of all her daughter has achieved. Not only has she succeeded in university, but Claudia also served appear following her youthful sisters although Gabriela took company classes at Yakima Valley Faculty. That would not have been probable without the need of the selection of virtual education.

“For college students who know what they want and can do it independently, this is a fantastic factor,” Gabriela Ornelas stated.

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Open Enrollment Numbers Hide Obamacare’s Expensive Failures

Open Enrollment Numbers Hide Obamacare’s Expensive Failures

It is really beginning to appear a great deal like . . . open enrollment. On December 15, the Cost-effective Treatment Act’s indication-up period will formally close for protection that usually takes effect January 1.

The Biden administration has already begun crowing about how a lot of persons have signed up. In mid-November, Health and fitness and Human Providers Secretary Xavier Becerra boasted that 3.4 million men and women experienced enrolled between November 1 and 19. “This may be a pretty excellent Xmas for a good deal of Us residents,” he mentioned.

Days previously, President Biden introduced that enrollment was up 40{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in contrast to last 12 months, and that a the vast majority of Americans could get coverage for “$10 a month or fewer.”

But exchange ideas are only economical simply because Democrats have earmarked billions of dollars in new paying to include most enrollees’ rates. Somewhat than handle the fundamental complications with his outdated boss’s signature health care law, President Biden and his crew have offered insurers a direct line to the federal treasury.

It is an high priced misstep, and future generations will be trapped with the monthly bill.

Some 13.8 million people today signed up for Obamacare in 2021, a 21{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} improve from the previous 12 months. Last year’s enrollment surge—and this year’s projected increase—can be explained in aspect by the American Rescue Plan’s subsidy growth. At first established to lapse at the finish of this calendar year, the Inflation Reduction Act expanded these subsidies through the finish of 2025.

The plan did not just make Obamacare subsidies more generous. It also prolonged them to people today who make much more than 400{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of the poverty level—$111,000 for a household of 4 this yr. Entirely, these expanded subsidies expense $30 billion in 2022. The Congressional Price range Office estimates they’d price tag $248 billion in excess of the upcoming decade, if Congress extends them beyond 2025.

Advocates will tell you this is funds properly-spent, because rates would have been 53{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} larger this yr with no them.

That’s right. It normally takes an more $30 billion a 12 months in taxpayer revenue to make sure a system with the word “Affordable” in its identify is basically inexpensive.

The new paying out will not conclude there. The Biden administration is also offering publicly funded coverage to persons whom Obamacare explicitly slice out of its subsidy routine.

The law stipulates that folks supplied protection via work that is “unaffordable”—where their share of the top quality is much more than 9.83{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of their income—can get backed protection by way of the exchanges. But Obamacare determines affordability by searching at the charge of an employer-sponsored strategy for an individual. Very last 12 months, the regular staff share of the high quality for self-only protection was $1,327 per year for spouse and children coverage, it was $6,106.

If the employee’s share of the premium for a spouse and children prepare exceeds that 9.83{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} determine, way too bad—a worker’s dependents can’t claim sponsored trade protection.

In Oct, the Biden administration “fixed’ this “relatives glitch” by saying it would alternatively contemplate the price tag of loved ones coverage when pinpointing no matter whether an employer-sponsored prepare is cost-effective. The change will effectively changeover people with personal coverage onto taxpayer-funded exchange coverage.

According to the Kaiser Family Basis, roughly 90{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of the 5.1 million persons at the moment impacted by this glitch are presently coated by personal designs. The price tag of “repairing” it is approximately $45 billion around a ten years, in accordance to the CBO.

The White Residence estimates that only 200,000 persons will attain protection from this rule. According to Paragon Overall health Institute president Brian Blase, that suggests the federal authorities will devote about $225,000 above the upcoming 10 a long time for every single additional individual who receives coverage.

All these subsidies are just driving up the charge of coverage. According to facts from the Centers for Medicare and Medicaid Companies, the typical specific sector quality was just $242 a thirty day period in 2013—the calendar year in advance of Obamacare’s exchanges opened. By 2019, the typical quality was $589 a month.

Info from the Kaiser Household Foundation displays that the common deductible for a mid-stage silver program was $4,753 in 2022—up from $2,425 in 2014.

More substantial federal subsidies will not resolve this prolonged-term challenge. If anything at all, they make it worse.

By insulating enrollees from the correct charge of their health protection, Obamacare’s subsidies help insurers to hike premiums with out provoking outrage. Since the federal government is footing so substantially of the invoice, insurers have no incentive to press back on healthcare providers who want greater reimbursements. Insurers can basically elevate rates yet again and once again, continuing the cycle of runaway charges.

Democrats’ response to each wellness coverage challenge is to throw more cash at it. That technique only sets up future generations for a terrifying money reckoning. And that could be the Democrats’ goal—to establish the scenario for a federal takeover of the wellbeing insurance policy program à la Medicare for All.

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What’s new for ACA health insurance open enrollment : Shots

What’s new for ACA health insurance open enrollment : Shots
Illustration of a group of people putting together a large scale puzzle on the floor. The image on the puzzle is the health care cross. Medications surround the people putting the puzzle together.
Illustration of a group of people putting together a large scale puzzle on the floor. The image on the puzzle is the health care cross. Medications surround the people putting the puzzle together.

It’s fall again, meaning shorter days, cooler temperatures, and open enrollment for Affordable Care Act marketplace insurance — sign-ups begin this week for coverage that starts Jan. 1, 2023. Even though much of the ACA coverage stays the same from year to year, there have been a few changes you’ll want to take note of this fall, including those that might help you even if you don’t usually buy ACA insurance, but have been having trouble finding an affordable health plan through your employer.

In the past year, the Biden administration and Congress have taken steps — mainly related to premiums and subsidies — that will affect 2023 coverage, and could reduce your cost. Meanwhile, recent court decisions have triggered questions about what sorts of preventive care or abortion services each plan covers.

So, what’s new, and what should you know if you’re shopping for a health plan? Here are six things to keep in mind.

1. Sign up soon

Open enrollment for people who buy ACA health insurance via HealthCare.gov or one of the state exchanges begins Tuesday, Nov. 1 and, in most states, lasts through Jan. 15. To get coverage that begins Jan. 1, enrollment usually must occur by Dec. 15.

2. Your family might now qualify for a subsidy

One big change is that some families who were barred in past years from getting federal subsidies to help them purchase ACA coverage may now qualify.

Applying for health insurance doesn't have to be confusing. Here's a handy glossary

A rule recently finalized by the Treasury Department aims to address what has long been termed the “family glitch.” The change expands the number of families with job-based insurance who can choose to forgo their coverage at work and qualify for subsidies to get an ACA plan instead. The White House estimates that this adjustment could help about 1 million people gain coverage or get more affordable insurance.

Before, employees could qualify for a subsidy for marketplace insurance only if the cost of their employer-based coverage was considered unaffordable based on a threshold set each year by the IRS. But that determination took into account only how much workers would pay for insurance for themselves. The cost of adding family members to the plan was not part of the calculation, and family coverage is often far more expensive than employee-only coverage. The families of employees who fall into the “glitch,” either go uninsured or pay more through their jobs for coverage than they might if they were able to get an ACA subsidy.

Now, the rules say eligibility for the subsidy must also consider the cost of family coverage.

“For the first time, a lot of families will have a real choice between an offer of employer-sponsored coverage and a marketplace plan with subsidies,” says Sabrina Corlette, a researcher and co-director at Georgetown University’s Center on Health Insurance Reforms.

Workers will now be able to get marketplace subsidies if their share of the premium for their job-based coverage exceeds 9.12{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of their expected 2023 income.

Health Costs Bear Down On Families Who Don't Qualify For ACA Subsidies

For Some Uninsured, Simply Signing Up Is A Challenge

Thanks to the change in the rules, two calculations now will occur: the cost of the employee-only coverage as a percentage of the worker’s income and the cost of adding family members. In some cases, the worker may decide to remain on the employer plan because his or her payment toward coverage falls below the affordability threshold, but the family members will be able to get a subsidized ACA plan.

Previous legislative efforts to resolve the family glitch failed, and the Biden administration’s use of regulation to fix it is controversial. The move might ultimately be challenged in court. Still, the rules are in place for 2023, and experts, including Corlette, say families who could benefit should go ahead and enroll.

“It will take a while for all that to get resolved,” she says, adding that it unlikely that there would be any decision in time to affect policies for 2023.

An Urban Institute analysis published last year estimated that the net savings per family from this change in regulations might be about $400 per person, and the cost to the federal government for new subsidies could be $2.6 billion a year. Not every family would save money by making the change, so experts say people should weigh the benefits and potential costs.

3. Preventive care will still be covered everywhere without a copay, but abortion coverage will vary

Many people with insurance are happy when they go in for a cancer screening, or seek other preventive care, and find they don’t have to pay anything out-of-pocket. That comes from a provision in the ACA that bars cost sharing for a range of preventive services, including certain tests, vaccines, and drugs. But a September ruling by U.S. District Judge Reed O’Connor in Texas led to confusion about what might be included in that category next year. The judge declared unconstitutional one method the government uses to determine some of the preventive treatments that are covered without patient cost sharing.

Ultimately, that might mean patients will have to start paying a share of the cost of cancer screenings or pay part of the cost of drugs that prevent the transmission of HIV. The judge has yet to rule on how many people the case will affect. But, for now, the ruling applies only to the employers and individuals who brought the lawsuit. So, your no-cost screening mammogram or colonoscopy is still no-cost. Whatever the judge decides, his ruling is likely to be appealed, and no decision is expected before the start of the 2023 coverage year.

The other court decision that has raised questions is the Supreme Court ruling that overturned the constitutional right to an abortion. Even before that decision was announced in June, coverage of abortion services in insurance plans varied by plan and by state.

Now it’s even more complicated as more states move to ban or restrict abortion.

State insurance rules vary.

66 clinics stopped providing abortions in the 100 days since Roe fell

Twenty-six states restrict abortion coverage in ACA marketplace plans, while seven states require it as a benefit in both ACA plans and employer plans purchased from insurers, according to KFF. Those states that require abortion services to be covered are California, Illinois, Maine, Maryland, New York, Oregon and Washington.

If in doubt, employees and policyholders can check their insurance plan documents for information about covered benefits, including abortion services.

4. Premiums are going up, but that might not affect most people on ACA plans

Health insurers are raising premium rates for ACA plans and for employer coverage. But most people who get subsidies for their ACA health insurance won’t feel that pinch.

That’s because the subsidies are tied to the cost of the second-cheapest “silver” plan offered in an ACA marketplace. (Marketplace plans are offered in colored “tiers,” based on how much they potentially cost policyholders out-of-pocket.) As those baseline silver plans increase in cost, the subsidies also rise, offsetting all or most of the premium increases. Still, shop around, experts advise. Switching plans might prove cost-effective.

As for subsidies, passage this summer of the Inflation Reduction Act guaranteed that the enhanced subsidies that many Americans have received under legislation tied to the COVID-19 pandemic will remain in place.

People who earn up to 150{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of the federal poverty level — so make up to $20,385 for an individual and $27,465 for a couple — can get an ACA plan with no monthly premium. Consumers who earn up to 400{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of the federal poverty level — or $54,360 for an individual and $73,240 for a couple — get sliding-scale subsidies to help offset premium costs. And the premiums for ACA plans purchased by people who have higher incomes than that are also capped; according to the rules, they will need to pay no more than 8.5{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of their household income toward premiums.

For workers with job-based insurance, employers generally set the amount they must pay toward health coverage. Some employers may pass along their rising insurance costs by increasing the amounts taken out of paychecks to go toward premiums, setting higher deductibles or changing the health care benefits they offer. But anyone whose share of their job-based coverage is expected to exceed 9.12{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of their income in 2023 can check now to see whether they qualify for a subsidized ACA plan instead.

5. Debts owed to insurers or to the IRS won’t stop coverage

Thank COVID-19 for this one. Typically, people who get subsidies to buy ACA plans must prove to the government in their next tax filing that they received the correct subsidy, based on the income they actually received. If they failed to do that reconciliation with the IRS, policyholders would lose eligibility for the subsidy the next time they enrolled. But, because of ongoing COVID-related problems in processing at the IRS, those consumers will get another reprieve, continuing an effort set in place for tax year 2020 by the American Rescue Plan Act.

Also, insurers can no longer deny coverage to people or employers who owe past-due premiums for previous coverage, says Karen Pollitz, a senior fellow at KFF. This follows a reexamination of a wide variety of Medicare and ACA rules prompted by an April executive order from President Joe Biden.

“If people fell behind on their 2022 premiums, they nevertheless must be allowed to reenroll in 2023,” Pollitz says. “And when they make the first-month premium payment to activate coverage, the insurer must apply that payment to their January 2023 premium.”

6. Comparison shopping will likely be easier

Although ACA plans have always been required to cover a wide range of services and offer similar benefits, variation still existed in the amounts that patients paid for office visits and other out-of-pocket costs. Starting during this year’s open enrollment, new rules are taking effect that aim to make the comparison of plans easier. Under the rules, all ACA health insurers must offer a set of plans with specific, standardized benefits. The standard plans will, for example, have the same deductibles, copays, and other cost-sharing requirements. They will also offer more coverage before a patient has to start paying toward a deductible.

Health insurance prices for care are now out there, but finding them is an ordeal

Some states, such as California, already required similar standardization, but the new rules apply nationally to health plans sold on the federal marketplace, HealthCare.gov. Any insurer who offers a non-standard plan on the marketplace must now offer the standardized plans as well.

Under a different set of rules, starting Jan. 1, all health insurers must make available cost-comparison tools online or over the phone that can help patients predict their costs for 500 “shoppable services,” such as repairs to a knee joint, a colonoscopy, a chest X-ray or childbirth services.

KHN (Kaiser Health News) is an editorially independent, national program of the Kaiser Family Foundation {KFF).

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Confused About Health Insurance? For Open Enrollment Period, you Need Someone Like Quentella Perry in Your Life

Confused About Health Insurance? For Open Enrollment Period, you Need Someone Like Quentella Perry in Your Life

Regardless of the supply of well being coverage, very a lot all people is bewildered about it on some amount. But navigators can support guidebook you through the approach. (Inventory photograph)

By Devin Blake

This story was initially released by Milwaukee Community News Support, the place you can obtain other tales reporting on fifteen city neighborhoods in Milwaukee. Pay a visit to milwaukeenns.org.

When it arrives to well being coverage, certainty can look in shorter supply.

Meet up with Quentella Perry, whose position with the nonprofit Masking Wisconsin entails encouraging people plow as a result of the complexities. Just as accountants have their busy time all through tax time, persons like Perry have got their hands full serving to folks navigate the selections provided in the course of the Open Enrollment Time period from Nov. 1 to Jan. 15.

The Open up Enrollment Period is a time in the course of which persons can transform or indicator up for a health and fitness insurance coverage prepare – possibly by their employer or the federal Well being Insurance policy Market, if they qualify for people subsidies.

Outdoors of this time period of time, people today can enroll in designs only under sure instances, like getting a new job, receiving married or possessing a little one. If 1 meets the criteria, condition-run Medicaid programs, like Wisconsin’s BadgerCare Furthermore, can be enrolled in through the calendar year.

Irrespective of the supply of well being coverage, while, quite much anyone is puzzled about it on some degree.

This is wherever Perry and individuals like her occur in.

Perry will solve that confusion.

She will reply your concerns.

She will walk you by way of the ways.

You will arise from your conference with an coverage approach that satisfies your needs.

Perry is a certified well being insurance navigator at Masking Wisconsin, a nonprofit group based mostly out of College of Wisconsin-Madison that educates folks about wellbeing insurance coverage and assists them select a system. It operates throughout the condition, which includes in Milwaukee.

Masking Wisconsin is aspect of a coalition of organizations and agencies performing to raise enrollment among the all citizens but significantly these who are not insured.

There are 55,000 uninsured folks in Milwaukee County, and approximately 35,000 of them reside in the metropolis, according to info furnished by the Milwaukee Health and fitness Treatment Partnership. The nonprofit associates with wellbeing care providers, government businesses and group companies to serve vulnerable people.

Other organizations that employ navigators helping Milwaukee citizens include things like Gerald L. Ignace Indian Wellness Middle, Progressive Neighborhood Health and fitness Centers and Feeding The us.

A lot more than a work

Perry, 40, was born and elevated in Milwaukee. She has been a navigator for 4 yrs but was a accredited software counselor, or CAC, for lots of a long time in advance of that.

A CAC is a position staffed in a health-related environment, these as a medical center, to support clients when they use for health and fitness insurance coverage. CACs generally changeover into navigators. Navigators have extra practical experience and can guide CACs when they come across especially intricate or demanding circumstances.

“This is my passion. I think training is crucial. Educating people within the neighborhood is critical. This is a little something I really like accomplishing, and this is why I keep on to do this work,” Perry mentioned.

“We don’t acquire commissions all the data we give is neutral. Our companies are free of charge to people today,” she claimed. “A good deal of the agent brokers – they function off commission – and persons have a tough time making an attempt to figure out if they have their best curiosity in brain.”

Education ought to normally be the first goal of a navigator, mentioned Cheryl Isabell, Milwaukee community engagement lead at Covering Wisconsin.

“To comprehend what a high quality is … . To describe to them what a copay is. If you have hardly ever experienced insurance policy, or have experienced to spend for health insurance policy coverage, you really don’t know,” Isabell said.

All the details and documentation can be tricky to keep track of — even for individuals who are fluent in the system.

“It’s very complicated,” said Winona Grieger, navigator at Gerald L. Ignace Indian Health Middle. “Every particular person that you function with – it’s by no means the same. Almost everything is normally different.”

Right after the client understands all these going elements, “then we talk about distinct designs,” Isabell mentioned.

Officials urge you to enroll

The Wisconsin Department of Wellbeing Solutions has sent out a “call to action” to corporations like Covering Wisconsin.

The mandate is uncomplicated: Enroll, enroll, enroll.

The explanation for the call to motion, in addition to the selection of uninsured men and women, is mainly because there is supplemental money guidance for overall health protection that was not readily available in previous decades.

If folks “have seemed prior to and just chose not to have wellbeing insurance coverage coverage because it wasn’t very affordable for them, they should really glimpse again,” Isabell claimed.

A further key modify is fixing what insurance policy pros simply call the “family glitch.”

“If you’re used, your employer could provide wellness coverage protection, but it is only very affordable for the personnel – the family members prepare might be unaffordable,” stated Isabell. Up till now, those family members have been not suitable for alternative guidance as a result of the market, which intended that the solutions to insure one’s family customers were being among a plan that was prohibitively expensive through the employer or a plan without having economic aid by the market.

“Now that the spouse and children glitch has been preset, the relatives associates have the chance to get people tax credits (through the marketplace), so now the entire household can be insured,” Isabell stated.

A further problem of distinct urgency for navigators is the opportunity close of the federal community overall health emergency, which has authorized individuals included by BadgerCare Additionally to keep coverage regardless of improvements in their revenue or domestic measurement. BadgerCare Additionally recipients have also not been required to update their information, which is needed just about every 12 months underneath ordinary conditions.

When the community wellness emergency finally does close, recipients will need to update their data and be re-evaluated to ascertain if they can keep their coverage.

Even though the community health and fitness unexpected emergency has been prolonged 11 instances due to the fact its first declaration in January 2020 and is at this time prolonged until eventually Jan. 11, lots of health care industry experts anticipate its conclude in the coming year.

“A good deal of men and women are applied to having support via the condition program, and with everyone likely again to operate and everybody becoming employed, some men and women will possibly be at a decline of their protection, for the reason that of them getting above the profits restrict,” Perry claimed.

For additional facts

To make an appointment with a navigator at a person of a selection of organizations, you can go to. https://coveringwi.org/enroll

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Medicare Advantage in 2022: Enrollment Update and Key Trends

Medicare Advantage in 2022: Enrollment Update and Key Trends

Since 2006, the role of Medicare Advantage, the private plan alternative to traditional Medicare, has steadily grown. In 2022, more than 28 million people are enrolled in a Medicare Advantage plan, accounting for nearly half or 48 percent of the eligible Medicare population, and $427 billion (or 55{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) of total federal Medicare spending (net of premiums). The average Medicare beneficiary in 2022 has access to 39 Medicare Advantage plans, the largest number of options available in more than a decade.

To better understand trends in the growth of the program, this brief provides current information about Medicare Advantage enrollment, including the types of plans in which Medicare beneficiaries are enrolled, and how enrollment varies across geographic areas. A second, companion analysis describes Medicare Advantage premiums, out-of-pocket limits, cost sharing, extra benefits offered, prior authorization requirements, and star ratings in 2022.

The share of eligible Medicare beneficiaries enrolled in Medicare Advantage has more than doubled since 2007

In 2022, nearly half of (48{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) eligible Medicare beneficiaries – 28.4 million people out of 58.6 million Medicare beneficiaries overall – are enrolled in Medicare Advantage plans. Medicare Advantage enrollment as a share of the eligible Medicare population has more than doubled from 2007 to 2022 (19{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} to 48{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}). KFF now calculates the share of eligible Medicare beneficiaries enrolled in Medicare Advantage, meaning they must have both Part A and B coverage. This affects both 2022 data as well as trends over time. The share would be somewhat smaller if based on the total Medicare population that includes 5.7 million beneficiaries with Part A only or Part B only who are not generally eligible to enroll in a Medicare Advantage plan. See methods for more details.

Between 2021 and 2022, total Medicare Advantage enrollment grew by about 2.2 million beneficiaries, or 8 percent – a slightly slower growth rate than the prior year (10{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}). The Congressional Budget Office (CBO) projects that the share of all Medicare beneficiaries enrolled in Medicare Advantage plans will rise to 61 percent by 2032 (Figure 2).

In 2022, two-thirds of Medicare Advantage enrollees are in individual plans that are open for general enrollment

Two-thirds (66{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) of Medicare Advantage enrollees, or 18.7 million people, are in plans generally available to all beneficiaries for individual enrollment. That is an increase of 1.3 million enrollees compared to 2021. Individual plans have accounted for approximately the same share of total Medicare Advantage enrollment since 2018.

Nearly one in five Medicare Advantage enrollees (18{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) are in group plans offered to retirees by employers and unions in 2022

Nearly 5.1 million Medicare Advantage enrollees are in a group plan offered to retirees by an employer or union. While this is roughly the same share of enrollment since 2010 (18{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), the actual number has increased from 1.8 million in 2010 to 5.1 million in 2022 (Figure 4). With a group plan, an employer or union contracts with an insurer and Medicare pays the insurer a fixed amount per enrollee to provide benefits covered by Medicare. For example, some states, such as Illinois and Pennsylvania, provide health insurance benefits to their Medicare-eligible retirees exclusively through Medicare Advantage plans. As with other Medicare Advantage plans, employer and union group plans often provide additional benefits and/or lower cost sharing than traditional Medicare and are eligible for bonus payments. The employer or union (and sometimes the retiree) may also pay an additional premium for these supplemental benefits. Group enrollees comprise a disproportionately large share of Medicare Advantage enrollees in six states: Alaska (99{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), Michigan (42{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), Maryland (36{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), West Virginia (35{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), New Jersey (35{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), and Illinois (30{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}).

More than 4.6 million Medicare beneficiaries are enrolled in Special Needs Plans in 2022

More than 4.6 million Medicare beneficiaries are enrolled in Special Needs Plans (SNPs). SNPs restrict enrollment to specific types of beneficiaries with significant or relatively specialized care needs, or who qualify because they are eligible for both Medicare and Medicaid. The majority of SNP enrollees (89{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) are in plans for beneficiaries dually enrolled in both Medicare and Medicaid (D-SNPs). Another 9 percent of SNP enrollees are in plans for people with severe chronic or disabling conditions (C-SNPs) and 2 percent are in plans for beneficiaries requiring a nursing home or institutional level of care (I-SNPs).

While D-SNPs are designed specifically for dually-eligible beneficiaries, 1.9 million Medicare beneficiaries with Medicaid were enrolled in non-SNP Medicare Advantage plans in 2020 (the most recent year for which this data is available).

Enrollment in SNPs increased from 3.8 million beneficiaries in 2021 to 4.6 million beneficiaries in 2022 (20{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} increase), and accounts for about 16{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of total Medicare Advantage enrollment in 2022, up from 11{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in 2011, with some variation across states. In the District of Columbia and Puerto Rico, SNPs comprise about half of all Medicare Advantage enrollees (47{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in DC and 48{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in PR). In 11 states, SNP enrollment accounts for about one-fifth of Medicare Advantage enrollment (29{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in MS, 27{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in NY and in LA, 24{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in AR and in FL, 23{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in GA, 22{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in SC, 21{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in CT, and 20{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in TN, in AZ, and in HI). More than 95{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of C-SNP enrollees (about 380,000 people) are in plans for people with diabetes or cardiovascular conditions in 2022. Enrollment in I-SNPs has been increasing slightly, but is still fewer than 100,000.

The share of Medicare beneficiaries in Medicare Advantage plans, by state, ranges from 1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} to 59{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}

The share of Medicare beneficiaries in Medicare Advantage plans varies across the country, but in 25 states, at least half of all Medicare beneficiaries are enrolled in Medicare Advantage plans. In contrast, Medicare Advantage enrollment is relatively low (less than 20 percent) in four mostly rural states (SD, ND, WY, and AK). Overall, Puerto Rico has the highest Medicare Advantage penetration, with 93 percent of Medicare beneficiaries enrolled in a Medicare Advantage plan. This may be due in part to the high share of beneficiaries in Puerto Rico with low incomes who are dually enrolled in Medicare and Medicaid, as noted above.

The share of Medicare beneficiaries in Medicare Advantage plans varies widely across counties

The share of Medicare beneficiaries enrolled in Medicare Advantage varies widely across counties. For example, in Florida, 56{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of all Medicare beneficiaries in the state are enrolled in Medicare Advantage, ranging from 19{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in Monroe County (Key West) to 78{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in Miami-Dade County. In Ohio, 52{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of all Medicare beneficiaries are enrolled in Medicare Advantage, with the share ranging from 30{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in Mercer County (Celina) to 64{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in Stark County (Canton).

In 2022, one in five (21{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) Medicare beneficiaries live in a county where at least 60 percent of all Medicare beneficiaries in that county are enrolled in Medicare Advantage plans (321 counties). That is substantially more than in 2010 when just 3 percent of the Medicare population lived in a county where 60 percent or more of Medicare beneficiaries were enrolled in a Medicare Advantage plan (83 counties). Many counties with high Medicare Advantage penetration are centered around relatively large, urban areas, such as Monroe County, NY (78{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), which includes Rochester, and Allegheny County, PA (72{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), which includes Pittsburgh. However, some urban areas, such as Baltimore City, MD (33{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), Charleston, SC (33{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), and Cook County, IL (Chicago, 39{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) have lower Medicare Advantage enrollment.

UnitedHealthcare and Humana account for nearly half of all Medicare Advantage enrollees nationwide in 2022

Medicare Advantage enrollment is highly concentrated among a small number of firms. UnitedHealthcare and Humana together account for 46 percent of all Medicare Advantage enrollees nationwide. In nearly a third of counties (29{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}; or 945 counties), these two firms account for at least 75{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of Medicare Advantage enrollment. (BCBS affiliates (including Anthem BCBS plans) account for 14 percent of enrollment, and four firms (CVS Health, Kaiser Permanente, Centene, and Cigna) account for another 24 percent of enrollment in 2022.

UnitedHealthcare and Humana have consistently accounted for a relatively large share of Medicare Advantage enrollment

UnitedHealthcare has had the largest share of Medicare Advantage enrollment and largest growth in enrollment since 2010, increasing from 20 percent of all Medicare Advantage enrollment in 2010 to 28 percent in 2022. Humana has also had a high share of Medicare Advantage enrollment, though its share of enrollment has grown more slowly, from 16 percent in 2010 to 18 percent in 2022. BCBS plans share of enrollment has been more constant over time, but has declined moderately since 2014. CVS Health, which purchased Aetna in 2018, has seen its share of enrollment nearly double from 6 percent in 2010 to 11 percent in 2022. Kaiser Permanente now accounts for 6{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of total enrollment, a moderate decline as a share of total since 2010 (9{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}), mainly due to the growth of enrollment in plans offered by other insurers and only a modest increase in enrollment growth for Kaiser Permanente over that time. However, for those insurers that have seen declines in their overall share of enrollment, the actual number of enrollees for each insurer is larger than it was in 2010.

For the sixth year in a row, enrollment in UnitedHealthcare’s plans grew more than any other firm, increasing by more than 749,000 beneficiaries between March 2021 and March 2022. Centene had the second largest growth in plan year enrollment, which was a little less than half of UnitedHealthcare’s with an increase of about 306,000 beneficiaries between March 2021 and March 2022. BCBS plans had the third highest growth in plan year enrollment of 293,000 beneficiaries between March 2021 and March 2022. CVS Health had the fourth largest growth in plan enrollment with an increase of about 282,000, followed by Humana, increasing by about 250,000 beneficiaries between March 2021 and March 2022. However, Cigna actually lost enrollees, declining by about 12,000 between March 2021 and March 2022.

Discussion

Medicare Advantage enrollment has increased steadily since 2006, with nearly half (48{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) of all eligible Medicare beneficiaries enrolled in Medicare Advantage plans in 2022. The share of Medicare Advantage enrollees varies across the country: in 25 states and Puerto Rico, at least 50 percent of Medicare beneficiaries are enrolled in Medicare Advantage plans in 2022. In a growing number of counties, 60 percent or more of all Medicare beneficiaries are in a Medicare Advantage plan, in lieu of traditional Medicare. Enrollment continues to be highly concentrated among a handful of firms, both nationally and in local markets, with UnitedHealthcare and Humana together accounting for 46 percent of enrollment in 2022.

As Medicare Advantage takes on an even larger presence in the Medicare program, and with current payments to plans higher for Medicare Advantage than for traditional Medicare for similar beneficiaries, it will be increasingly important to assess how well Medicare’s current payment methodology for Medicare Advantage is working to enhance efficiency and hold down beneficiary costs and Medicare spending. It will also be important to monitor how well beneficiaries are being served in both Medicare Advantage and traditional Medicare, in terms of costs, benefits, quality of care, patient outcomes, and access to providers, with particular attention to those with the greatest needs.

Meredith Freed, Jeannie Fuglesten Biniek, Tricia Neuman are with KFF.

Anthony Damico is an independent consultant.

This analysis uses data from the Centers for Medicare & Medicaid Services (CMS) Medicare Advantage Enrollment, Benefit and Landscape files for the respective year. KFF uses the Medicare Enrollment Dashboard for enrollment data, from March of each year.

In previous years, KFF had calculated the share of Medicare beneficiaries enrolled in Medicare Advantage by including Medicare beneficiaries with either Part A and/or B coverage. We have modified our approach this year to estimate the share enrolled among beneficiaries eligible for Medicare Advantage who have both Medicare Part A and Medicare B. In the past, the number of beneficiaries enrolled in Medicare Advantage was smaller and therefore the difference between the share enrolled with Part A and/or B vs Part A and B was also smaller. For example, in 2010, 24{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of all Medicare enrollees were in enrolled in Medicare Advantage versus 25{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} with just Parts A and B. However, these shares have diverged over time: in 2022, 44{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of all Medicare enrollees were in enrolled in Medicare Advantage versus 48{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} with just Parts A and B. These changes are reflected in both the 2022 data and in data displayed trending back to 2010.

Additionally, in previous years, KFF had used the term Medicare Advantage to refer to Medicare Advantage plans as well as other types of private plans, including cost plans, PACE plans, and HCPPs. However, cost plans, PACE plans, HCPPs are now excluded from this analysis in addition to MMPs. In this analysis, KFF excludes these other plans as some may have different enrollment requirements than Medicare Advantage plans (e.g., may be available to beneficiaries with only Part B coverage) and in some cases, may be paid differently than Medicare Advantage plans. These exclusions are reflected in both the 2022 data and in data displayed trending back to 2010.

Enrollment counts in publications by firms operating in the Medicare Advantage market, such as company financial statements, might differ from KFF estimates due to inclusion or exclusion of certain plan types, such as SNPs or employer group health plans.