The State of Medicare Advantage: A Member Perspective

In 2024, the Medicare Advantage (MA) landscape has undergone significant shifts, marking a stark contrast to the stability of previous years.  Increased focus on growing enrollment, improving affordability, and advancing health equity has driven a 200% growth in beneficiaries since 2014. Today, over 33.8 million people are enrolled in MA plans—representing 55% of Medicare-eligible individuals. The shift in health equity has also resulted in 98% of beneficiaries enrolling in a Medicare Advantage Prescription Drug (MA-PD) plan. Similarly, the number of beneficiaries in Special Needs Plans (SNPs) has surged from 2.3 million in 2017 to 6.6 million in 2024. However, this rapid growth has brought new challenges, including increased regulatory scrutiny, prior authorization reform, and the constant balancing act between cost containment and providing affordable, high-quality care. 

Medicare Advantage member perspectives

In such a complex Medicare landscape, it is particularly important to focus on the member perspective and the overarching healthcare experience. This set the stage for a Medicare Advantage member panel at this year’s RISE West conference in Colorado Springs. Consumer panels offer something rare and invaluable at conferences -- the chance to hear directly from the members impacted by our work. These discussions bring the member perspective to life by providing valuable insight into the impact of the important work that payors, providers, government, and community partners do on a day-to-day basis. Hearing directly from members fosters empathy from healthcare professionals, researchers, and policymakers and reminds attendees that behind every policy, every healthcare decision, and every program there are real people with unique individual stories and needs. 

This year’s RISE West Member Focus panel was no exception. Moderated by Engagys’ Co-Founder and Managing Partner, Kathleen Ellmore, the panel featured nine local Medicare Advantage members, enrolled in plans from major national payors including United Healthcare, Humana, and Aetna. After spending the first half of the conference learning about healthcare policy changes, risk adjustment, and health tech advancements like artificial intelligence (AI), the member panel tied everything together.  It connected the dots between the industry's complex topics and the real-world impact on the people it serves. The panelists shared their thoughts on the state of Medicare Advantage in 2024 and highlighted what they believe are the top three issues in healthcare today. 

Member priorities for picking a health plan

The panelists ranged from those newly eligible for Medicare to long-term enrollees who have been with the same plan for over a decade. Despite varying levels of experience with Medicare Advantage, most members shared similar priorities when choosing a plan. 

• Cost: Consumers want their healthcare to be affordable. They want reasonable premiums, co-pays, and low out-of-pocket maximums. Prescription medications, in particular, remain a significant cost concern.  Notably, 66% of MA plans in 2024 do not include a monthly premium, making cost a key selling point for many.
• Comprehensive coverage: Members who have complex physical and behavioral health needs emphasized the importance of having their necessary healthcare services and medications covered. For example, the rising price of insulin -- up more than 125% since 2018—has led to increasing out-of-pocket expenses, making coverage a critical factor for many. 
• Access: Similarly, almost every single panelist mentioned the need for plans that include their preferred healthcare providers and specialists, including dental and vision care. One panelist even shared that she was prepared to switch plans next year to ensure that her dentist was in-network and covered the dental services she needs and uses on a regular basis. 

Meet members where they are

Medicare Advantage members face a daunting array of choices during open enrollment. In 2024, a total of 3,959 MA plans were available across the U.S. for individual enrollment (not including SNP, EGHPs, HCPPs, PACE plans, cost plans, and MMPs).  The sheer volume of information, disparate data and information systems, and the local and national resources that are shared with members to help them make these decisions can be overwhelming, causing decision-making to be even more confusing for new enrollees. A few key takeaways emerged from the panel’s discussion: 

• Adopt a member-centered approach: Tailor plan options to meet the individuals’ unique needs, making it easier to identify the best fit. 
• Leverage AI for more personalized communication: Health plans should consider investing in AI-driven solutions that help members compare and select plans with greater ease and personalization. The right technology can reduce confusion and streamline the process, improving the overall member experience 
• Utilize broker support: Many panelists reported positive experiences when working with a broker to select their health plan. Brokers typically provide their services at no cost to the member and offer expert guidance, helping clarify options and provide a deeper understanding of Medicare Advantage (MA). They also compare plans across multiple payors, expanding the range of choices available to beneficiaries. 

Keep it simple

For the best member experience, keep your communications: 

• Straightforward and direct: Tell the member what they need to know. Too many details can distract from the key pieces of information they need to know. 
• Simple: Use formatting techniques like bullet points and bold text to make information easier to read and navigate. Self-service options, like a member portal, can also streamline access by organizing important details in one convenient location. 
• Succinct: Don’t make your members dig for information; instead, communicate highlights and “need-to-know” information for them.

Conclusion 

As Medicare Advantage continues to grow and evolve, it is clear the member experience must remain at the heart of the conversation. Insights from the RISE West 2024 Member Focus panel reinforce the need for health plans to prioritize affordability, comprehensive coverage, and easy access to preferred providers. As the industry navigates regulatory challenges and technological advancements, keeping the member perspective front and center will be critical to maintaining trust and delivering value. By simplifying communications, offering personalized solutions, and meeting members where they are, payer organizations can ensure they not only meet, but exceed, the expectations of the millions of Medicare Advantage beneficiaries today and in the future.