Medicare Advantage Market Size, Share, Growth, and Industry Analysis, By Type (Health maintenance organizations (HMO), Preferred Provider Organizations (PPO), Special Need Plans and Private Fee for Service, Medical Savings Accounts and Others), By Application (Agents or Brokers and Direct Writing) and Regional Forecast to 2033

MEDICARE ADVANTAGE MARKET REPORT OVERVIEW

The global Medicare Advantage market size expanded rapidly in 2022 and is projected to grow substantially by 2028, exhibiting a prodigious CAGR during the forecast period.

Medicare Advantage (or Medicare Part C) is health insurance you get through private insurance companies that are approved by Medicare. It allows some Medicare beneficiaries to get their Medicare benefits in an alternative way.

GLOBAL CRISES IMPACTING MEDICARE ADVANTAGE MARKET
COVID-19 IMPACT or RUSSIA-UKRAINE WAR IMPACT or ISRAEL-HAMAS WAR IMPACT

COVID-19 IMPACT

Medicare Advantage Industry Had a positive Effect Due to Increased Enrollment and Demand during COVID-19 Pandemic

The global COVID-19 pandemic has been unprecedented and staggering, with the market experiencing higher-than-anticipated demand across all regions compared to pre-pandemic levels. The sudden market growth reflected by the rise in CAGR is attributable to market’s growth and demand returning to pre-pandemic levels.

More people over age 65 signed up for Medicare Advantage during the COVID-19 pandemic when they learned how important healthcare coverage is. A great number of beneficiaries considered plans that offered telehealth, covered drugs over the original Medicare option and better coordinated their medical care.

LATEST TRENDS

Expansion of Special Needs Plans (SNPs) to Propel Market Growth

Dual-Eligible SNPs (D-SNPs) under Special Needs Plans have experienced great growth. At the end of 2024, the SNP program had over 6.6 million enrolled participants who made up 20% of MA enrollment. This means there was a 16% increase from the previous year, confirming more attention to detailed care for those requiring help with their health.

MEDICARE ADVANTAGE MARKET SEGMENTATION

By Type

Based on type the global market can be categorized into Health maintenance organizations (HMO), Preferred Provider Organizations (PPO), Special Need Plans and Private Fee for Service, Medical Savings Accounts and Others.

• Health maintenance organizations (HMO)- Under an HMO, members of Medicare Advantage are required to choose their doctors, hospitals and other providers from a network chosen by the plan.
• Preferred Provider Organizations (PPO)- Unlike HMOs, joining a PPO allows you to use different healthcare providers.
• Special Need Plans- SNPs are Medicare Advantage plans created especially for those who are dealing with specific health issues.
• Private Fee for Service- Members can choose any Medicare-accepting provider if the provider agrees to what PFFS plans pay for services.
• Medical Savings Accounts- MSAs are designed to pair a high-deductible Medicare Advantage plan with a special account that offers tax savings.

By Application

Based on application the global market can be categorized into Agents or Brokers and Direct Writing.

• Agents or Brokers- Brokers and agents connect insurance providers and people interested in Medicare Advantage plans.
• Direct Writing- Direct writing means that Medicare Advantage companies promote and sell their plans directly without involving other individuals or organizations.

DRIVING FACTORS

Increasing Aging Population to Drive Market Advancement

One of the key driving factors in the Medicare Advantage market growth is the Increasing Aging Population. The major factor driving the Medicare Advantage market is the fast increase of elderly people in developed countries such as the United States. With the baby boomers getting older, many more people now qualify for Medicare.

Attractive Plan Benefits and Coverage Options to Expand the Market

Those who join Medicare Advantage may get bonuses like coverage for vision, dental, hearing, wellness and at times prescription drugs, compared to Original Medicare. The extra benefits attract beneficiaries who want all their healthcare services included in a single plan.

RESTRAINING FACTOR

Regulatory and Policy Uncertainty to potentially impede Market Growth

Because Medicare Advantage is run in a highly regulated and diverse environment, the market is always evolving. The way government policies and reimbursement rates set by CMS influence both the design and cost of insurance plans. Whenever regulations are changed or become unclear—such as with new payments, benefits or enrollment process—this can be challenging for insurers.

 OPPORTUNITY

Rising Preference for Value-Based Care To Create Opportunity for the Product in the Market

Around the world, healthcare is moving from being paid per service toward organizations that prioritize patient results and money management. Much of today’s trend can be met by Medicare Advantage plans which often give access to coordinated care, various preventive services and resources for managing chronic diseases.

CHALLENGE

Rising Healthcare Costs and Utilization Could Be a Potential Challenge for Consumers

Since they work under fixed payments given by CMS, Medicare Advantage plans have to face serious challenges from rising healthcare costs. Increased medical costs thanks to new treatments, older populations and more visits create a challenge for plans to watch their budgets.

MEDICARE ADVANTAGE MARKET REGIONAL INSIGHTS

●       NORTH AMERICA

North America has emerged as the most dominant region in the Medicare Advantage market share due to a convergence of factors that propel its leadership in this dynamic industry. Across North America, but mostly in the United States, Medicare Advantage is most important. Mostly, this is because the country relies on Medicare, especially the Medicare Advantage program (Part C), as a main support for its healthcare system.

• EUROPE

Because most European nations have national health systems, the Medicare Advantage market is not clearly defined.

• ASIA

There is major growth potential for Medicare Advantage in the Asia Pacific because its elderly population is rising and people are becoming more aware of healthcare.

KEY INDUSTRY PLAYERS

Key Industry Players Shaping the Medicare Advantage Market Through Innovation and Market Expansion

Key enterprise players are shaping the Medicare Advantage marketplace through strategic innovation and marketplace growth. To cope with more competitors and new rules, leading firms in the Medicare Advantage market are using different methods to hold on to their presence and expand. They are working hard to make the experience for members better by providing extra services such as telehealth, disease management, wellness programs and custom care coordination to boost health results and their happiness.

LIST OF TOP MEDICARE ADVANTAGE COMPANIES          

● HCSC. (U.S.)

• Experience Health, Inc. (U.S.)
• Humana (U.S.)
• Anthem (U.S.)
• Oscar (U.S.)

KEY INDUSTRY DEVELOPMENTS

2024: Extensions to Medicare coverage in 42 new counties meant that 96% of individuals who can purchase Medicare plans now qualify for UnitedHealthcare.

REPORT COVERAGE

The study encompasses a comprehensive SWOT analysis and provides insights into future developments within the market. It examines various factors that contribute to the growth of the market, exploring a wide range of market categories and potential applications that may impact its trajectory in the coming years. The analysis takes into account both current trends and historical turning points, providing a holistic understanding of the market's components and identifying potential areas for growth.

The research report delves into market segmentation, utilizing both qualitative and quantitative research methods to provide a thorough analysis. It also evaluates the impact of financial and strategic perspectives on the market. Furthermore, the report presents national and regional assessments, considering the dominant forces of supply and demand that influence market growth. The competitive landscape is meticulously detailed, including market shares of significant competitors. The report incorporates novel research methodologies and player strategies tailored for the anticipated time frame. Overall, it offers valuable and comprehensive insights into the market dynamics in a formal and easily understandable manner.