Medical Expense and Utilization Trends in Medicare Advantage

This document is a report detailing the results of a survey conducted by AHIP in February 2024, focusing on medical expenses and utilization trends in the Medicare Advantage market during 2023. The survey aimed to gather insights on quarterly trends in enrollee utilization and associated plan costs, particularly in light of proposed benchmark rates for Medicare Advantage capitation rates and payment policies for 2025. The findings indicate a significant year-over-year increase in per member per month (PMPM) total medical expenses, with the fourth quarter of 2023 showing an 8.1% increase compared to the same quarter in 2022. Additionally, the survey revealed substantial increases in utilization across various service types, notably in outpatient surgery, emergency room visits, and general outpatient visits. The methodology involved responses from 15 health insurance providers, representing 75% of the Medicare Advantage market, which collectively serve 24 million enrollees. The report includes detailed statistics on PMPM expenses and utilization changes for each quarter of 2023.