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Home Global Executive Dashboard Medicare Advantage Enrollment

Medicare Advantage Enrollment

Remarkable range of Medicare Advantage plan enrollment across the United States.

The percentage of Medicare beneficiaries enrolled in a Medicare Advantage plan varies from 45 percent in Hawaii to 1 percent in Alaska.

  • Percentage enrolled in Medicare Advantage nationally: 35.3. National Medicare Advantage enrollment: 24.7 million
  • Rates of enrollment in Medicare Advantage vary substantially across the United States and the District of Columbia, from less than 5 percent of Medicare beneficiaries in Alaska, North Dakota, and Wyoming to more than 40 percent in Alabama, Connecticut, Florida, Hawaii, Michigan, Oregon, and Pennsylvania.

HMO Enrollment

Enrollment in HMOs has doubled over the past decade.

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
HMO 7.3 7.8 8.5 9.4 10.1 11.1 11.8 12.4 13.1 14.0 15.2
PPO 1.3 2.2 2.8 3.2 3.7 4.1 4.2 5.0 5.7 6.9 8.0
Private Fee-for-Service 1.7 0.6 0.5 0.4 0.3 0.3 0.2 0.2 0.2 0.1 0.1
Regional PPO 0.8 1.1 0.9 1.1 1.2 1.2 1.3 1.4 1.3 1.3 1.2
Total 11.0 11.7 12.8 14.1 15.4 16.7 17.5 18.9 20.3 22.3 24.4
  • Local coordinated care plans (HMOs and PPOs) often serve different markets or regions than regional PPO plans. Local plans typically provide services to Medicare beneficiaries in one county or multiple counties. Regional plans are required to provide services to beneficiaries in a single state or in multiple states, with the benefit package and premiums uniform across the state or states served.
  • The majority of Medicare beneficiaries, more than 23 million, are enrolled in a local coordinated care plan, either an HMO or PPO.
  • Enrollment in local coordinated care plans increased substantially throughout the past decade, with enrollment in HMOs rising more than twofold (from 7.3 million to 15.2 million) and enrollment in local PPOs rising sixfold (from 1.3 million to 8.0 million) between 2010 and 2020.
  • Reductions in private-fee-for-service enrollment (PFFS) over the past decade reflect changes to plan network requirements that took effect in 2011 following enactment of the Medicare Improvement for Patients and Providers Act of 2008. These changes led to significant reductions in the number of Medicare PFFS plans.

Source: CMS Monthly Contract and Summary Enrollment Reports, March 2009–2020.

Note: Enrollment estimates do not include records denoted as pending state or county designation; totals include beneficiaries enrolled in employer/union-only group plans.  Total does not include all Medicare Advantage plan types; actual enrollment is higher than shown in this table. 

In 2020, approximately 37 percent of Medicare beneficiaries were enrolled in a MA plan.

Enrollment in private Medicare Advantage plans more than doubled between 2010 and 2020.

  • Medicare Advantage (MA), or Part C, plans are offered by private companies that contract with Medicare to provide Part A and Part B benefits to enrollees. Most plans also provide Part D prescription drug coverage. The most common types of MA plans are health maintenance organizations (HMOs) and preferred provider organizations (PPOs). 
  • Enrollment in MA plans has grown steadily since 2010. Over the past decade, the number of beneficiaries in an MA plan rose from about 11 million to nearly 25 million, a 115 percent increase.

Source: CMS Medicare Advantage State/County Penetration File, March 2020.

Note: Enrollment estimates do not include records denoted as pending state or county designation. Data include counts for local Coordinated Care Plans (CCP); Regional CCP; Medical Savings Accounts (MSA); Private Fee-for-Service (PFFS); Demonstrations; National PACE; 1976 Cost; HCPP–1933 Cost; Employer Direct PFFS.

At the county level, enrollment rates vary from under 1 percent to about 67 percent.

Enrollment in Medicare Advantage plans varies widely, with rates lowest in the midwestern and western counties.

  • The lowest county-level Medicare Advantage (MA) rates are in regions of Alaska and counties in Wyoming and Montana, with less than 1 percent of Medicare beneficiaries enrolled in a plan.
  • Excluding regions of Puerto Rico, where enrollment rates approach 80 percent, areas with the highest MA rates are:
  • Miami-Dade County, Fla., and Monroe County, N.Y. (which includes Rochester), with over two-thirds of Medicare beneficiaries enrolled
  • Cambria, Beaver, Westmoreland, and Armstrong counties in Pennsylvania, with between 61 and 63 percent enrolled
  • Meeker and McLeod counties in Minnesota, with 63 percent and 62 percent enrolled
  • Ottawa County, Mich., with 62 percent enrolled
  • El Paso County, Texas, with 61 percent enrolled.

Source: CMS MA State/County Penetration File, 2020. 

Note: Enrollment estimates do not include records denoted as pending state or county designation.

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