October 15, 2020

Comparing the Demographics of Enrollees in Medicare Advantage and Fee-For-Service Medicare

Milliman findings show that, since 2013, Medicare Advantage enrollment grew by 111% among minority beneficiaries and 125% among dual-eligible beneficiaries


In 2019 there were 64 million Medicare beneficiaries. Twenty-four million of those beneficiaries chose to enroll in a Medicare Advantage plan; the remainder were covered by fee-for-service Medicare. Over 37% of the total Medicare beneficiary population chose Medicare Advantage. The Congressional Budget Office (CBO) projects that Medicare Advantage enrollment will grow to nearly 50% by 2029.1 To better understand the increasing role of Medicare Advantage for Medicare beneficiaries we looked at similarities and differences among enrollees in those two programs across several years. We conclude that overall the two programs both attract a broad mix of beneficiaries but there are some interesting differences. 

The age composition of Medicare Advantage and fee-for-service Medicare are largely similar but there are a few differences worth noting. A higher share of the fee-for-service Medicare population, 29%, is between the ages of 65 and 69 compared to 24% for Medicare Advantage. The opposite is true between 70 and 84. This age group represents 52% of Medicare Advantage enrollees versus 46% of fee-for-service Medicare beneficiaries. 

The share of the Medicare population enrolled in Medicare Advantage, excluding EGWPs, grew from 24% in 2013 to 33% in 2019. This represents a 63% increase in Medicare Advantage enrollment over that time period. Our examination of the journey of the 2013 Medicare beneficiaries through 2019 reflects this movement. 

  • Medicare Advantage enrollees are more likely to stay in Medicare Advantage. 85% of 2013 Medicare Advantage enrollment remained in Medicare Advantage through 2019, compared to 81% of fee-for-service Medicare beneficiaries.
  • In addition, 15% of the 2013 fee-for-service Medicare beneficiaries moved into Medicare Advantage between 2013 and 2019, compared to the 6% that left Medicare Advantage for fee-for-service Medicare. 

Racial minorities make up a larger share of the Medicare Advantage population than in fee-for-service Medicare (32% vs 21% in 2019). They also comprise a larger share of the 2013 beneficiaries that transitioned into Medicare Advantage (38% vs 35%) between 2013 and 2019. 

The number of dual-eligible beneficiaries, i.e., those enrolled in both Medicare and Medicaid, choosing Medicare Advantage increased significantly between 2013 and 2019. 

  • In 2013 there were 9.6 million full or partial dual beneficiaries, with 2.4 million (25%) enrolled in Medicare Advantage.
  • By 2019 the number had increased to 12.3 million, with 5.4 million, or 44%, enrolled in Medicare Advantage. 

This report was commissioned by the Better Medicare Alliance, Inc. 

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