Medicare Advantage plans saw utilization rates rise 8.1% in the fourth quarter of 2023, primarily driven by outpatient and emergency room services, according to an AHIP survey.
The survey was conducted in February and asked for a year-over-year percent change in per member per month total medical costs and percent change in utilization per 1000 members by service type. Responses were received from 15 payers that collectively serve 24 million Medicare Advantage enrollees across all 50 states.
Most plans noted a rise in musculoskeletal, circulatory system, and respiratory system surgeries as the main drivers of higher utilization.
On April 1, CMS finalized a slight decrease (0.16%) in Medicare Advantage benchmark payments for 2025.
Average change in utilization per 1000 members in Q4 2023:
- Outpatient surgery visits: 14.4%
- Outpatient visits (excluding ER and surgery): 8.7%
- Physician visits: 6%
- Inpatient adults: 5.3%
- Part B drug utilization: 5%
- ER visits: 4%