Competition and Consolidation in Medicare Advantage

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Background: Medicare Advantage (MA) serves roughly one in three (24 out of 68 million) Medicare beneficiaries and this number is expected to grow to about half (40 out of 80 million) of Medicare beneficiaries by 2030. Given this expected increase in demand for MA health plans, it is important to assess the relationship between market structure and benefit generosity to ensure that beneficiaries have equal access to high quality plans at low prices.Purpose: The purpose of this research is to assess how policy changes and market structures influence Medicare Advantage plan benefit designs. Data and Methods: This study uses publicly available MA data from the Centers for Medicare & Medicaid Services and the Area Health Resources File. Retrospective cross-sectional analyses examine contract consolidation and reconsolidation from 2012–2020, market competition and supplemental benefits in 2013, and market competition and maximum out-of-pocket limits in 2018. Key Results: Contract consolidations have declined in recent years, likely as a result of a policy that changed the calculation method of the star ratings among consolidated contracts. During the years that contract consolidations peaked, market concentration also increased. We find that the odds of a plan in a nonconcentrated market offering a transportation supplemental benefit is 2.8 times higher than a plan operating in a highly concentrated market, when holding all other predictors constant (p < 0.001). Similarly, plans in nonconcentrated service areas are 2.4 times more likely to offer a hearing benefit (p < 0.001) and 2.3 times more likely to offer a dental benefit (p < 0.001) than plans in highly concentrated markets. Regarding maximum out-of-pocket limits, we find that the odds of a plan in a highly concentrated market having a higher maximum limit is 1.6 times higher than a plan with a nonconcentrated market, when holding all other predictors constant (p = 0.049). Conclusion: MA contract consolidations have declined since 2016 but market concentration continues to increase. Market structure is important because we find that MA market concentration is associated with the offering of supplemental benefits and the level of maximum out-of-pocket limits.