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Medicare Advantage Plan Availability

All types of Medicare Advantage plans with Healthcare.

Among Medicare Advantage plan types, average 2021 premiums are lowest for HMOs and Special Needs Plans.

  • Ranging from $0 per month to $351 per month, premiums for Medicare Advantage plans average $28 per month in 2021.
  • Average premiums vary substantially by type of plan, with HMOs ($23) and Special Needs Plans ($25) having the lowest average monthly premiums.
  • Monthly premiums for regional PPOs, which average $73, and private fee-for-service plans, which average $78, are approximately three times higher than for either HMOs or Special Needs Plans.

Source: CMS Plan and Premium Information for Medicare Plans Offering Part D Coverage, 2021. 

Notes: PACE, Part B–only plans, employer-sponsored plans, and plans under sanction are excluded. Special Needs Plans are excluded from the “All Medicare Advantage Plans” average.

Maximum Out-of-Pocket (MOOP)

HMOs’ average in-network maximum out-of-pocket (MOOP) amount is about one-third less than the Medicare limit for 2021.

  • Each year, the Centers for Medicare and Medicaid Services (CMS) sets a Medicare Advantage (MA) maximum out-of-pocket (MOOP) limit to reduce beneficiary financial risk. Beneficiary cost-sharing for Part A and Part B services is waived once a beneficiary reaches the MOOP amount. The CMS-allowed MOOP limit provides a ceiling for MA plans’ MOOP limits, and plans may choose to set a lower limit. CMS has set the in-network, maximum out-of-pocket limit at $7,550 per year, up from the $6,700 limit set for 2010 to 2020.
  • Across all MA plans, the in-network MOOP limit averages $5,343, about 30 percent lower than the CMS-allowed MOOP limit.
  • MOOP amounts vary by plan type. Average annual MOOP among HMOs ($4,982) is about one-third lower, and average MOOP among local PPOs ($6,086) is about one-fifth lower than the CMS-allowed MOOP limit for 2021.

Source: CMS Medicare Advantage Landscape File, 2021.

Notes: PACE, Special Needs Plans, Part B–only plans, employer-sponsored plans, and plans under sanction are excluded.

In 2021, more Special Needs Plans than other Medicare Advantage plans offer popular supplemental benefits, such as eye exams, hearing exams, over-the-counter drugs, and transportation.

  • Medicare Advantage plans are required to provide coverage that is comparable to that provided under traditional Medicare Part A and Part B. Additionally, Medicare Advantage plans have the option of providing coverage for primarily health-related services that are not presently covered under Medicare fee-for-service. Comparing Special Needs Plans (SNPs) to all other Medicare Advantage plans, a substantially greater proportion of SNPs than other Medicare Advantage plans offer the more popular supplemental benefits, most significantly:
  • Eye and hearing exams are each offered by nine in ten SNPs, but only three quarters of other Medicare Advantage plans;
  • Over 91 percent of SNPs offer access to over-the-counter drugs, compared to 61 percent of other Medicare Advantage plans;
  • Non-medical emergency transportation services is offered by nearly 85 percent of SNPs, but only 36 percent of other Medicare Advantage plans;
  • Over 64 percent of SNPs provide access to limited meal benefits compared to slightly more than 44 percent of other Medicare Advantage plans.
  • Supplemental benefits may also include enhancements to traditional inpatient and outpatient services. Among the more popular of these, approximately 93 percent of SNPs and 75 percent of other Medicare Advantage plans waive the rule requiring hospitalization for 3 days for coverage of post-acute care at a skilled nursing facility (3-day SNF rule).

Source: CMS Plan Benefit Package, 2021 (Updated as of October 1, 2020).

Fewer than one in ten Medicare Advantage plans offer support for caregivers, in-home safety assessments, or other services that help people live independently in their homes.

  • In 2019, CMS expanded the definition of a “primarily health-related” supplemental benefit to include services or items that may be used to “diagnose, compensate for physical impairments, ameliorate the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and healthcare utilization.” This expanded definition opened the door for Medicare Advantage plans to provide benefits that, among others, included adult day health services, home-based palliative care, support for caregivers of enrollees, non-opioid pain management or therapeutic massages, and home and bathroom safety devices.
  • Among the expanded benefits that are offered by the greatest number of Medicare Advantage plans:
  • Over 19 percent of SNPs and 7 percent of other Medicare Advantage plans provide some coverage for in-home support services;
  • Bathroom safety devices are offered by 12 percent of SNPs and almost 7 percent of other Medicare Advantage plans; and
  • Telemonitoring services are offered by 11 percent of SNPs and 5 percent of other Medicare Advantage;
  • Benefits offered by the fewest plans include post-discharge medication reconciliation, in-home palliative care services, and support for caregivers. Each of these services are offered by fewer than 2 percent of SNPs and other Medicare Advantage plans.

Source: CMS Plan Benefit Package, 2021 (Updated as of October 1, 2020).

The number of Medicare Advantage plans available to Medicare beneficiaries has increased over the past decade, with 33 plans available, on average, in 2021.

  • Ranging from $0 per month to $351 per month, premiums for Medicare Advantage plans average $28 per month in 2021.
  • Average premiums vary substantially by type of plan, with HMOs ($23) and Special Needs Plans ($25) having the lowest average monthly premiums.
  • Monthly premiums for regional PPOs, which average $73, and private fee-for-service plans, which average $78, are approximately three times higher than for either HMOs or Special Needs Plans.

Source: CMS MA Landscape Source Files, 2010–2021.

Note: Data represent the average number of plans operating in counties across the U.S. and Puerto Rico, weighted by the number of Medicare beneficiaries in each year. (Data for 2021 are weighted by September 2020 beneficiaries.)  PACE, Special Needs Plans, Part B–only plans, employer-sponsored plans, plans under sanction, and records denoted as pending state or county designation are excluded.

Nearly all Medicare beneficiaries have access to at least one Medicare Advantage plan for 2021, typically an HMO or local PPO.

  • Throughout the past decade, nearly all Medicare beneficiaries have had access to at least one Medicare Advantage plan. In 2021, less than 1 percent of the U.S. population resided in an area without access to a plan.
  • Access to HMOs and local PPOs has increased over the past decade. In 2021, all but 4 percent of Medicare beneficiaries have access to at least one HMO, and only 6 percent lack access to a local PPO.
  • Access to regional PPOs and private fee-for-service plans declined substantially over the last decade. In 2021, more than one-quarter of the Medicare population does not have access to a regional PPO, and more than two-thirds do not have access to a private fee-for-service plan.

Sources: CMS MA Landscape Source File, 2010–2021.

Notes: Data for the following organization types are included: 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.

The number of Special Needs Plans (SNPs) has increased steadily in the past six years, totaling 1,019 in 2021.

  • The Medicare Modernization Act of 2003 established Medicare Special Needs Plans (SNPs) to provide coordinated care services to Medicare beneficiaries who are dually eligible for Medicare and Medicaid, require an institutional-level of care, and/or have a chronic and disabling condition.
  • Between 2010 and 2015, the number of SNPs fluctuated, but the number of SNPs increased steadily between 2016 and 2021. During these last six years, the number of SNPs nearly doubled, from 534 to 1,019 plans.
  • Of the more than 1,000 SNPs operating in 2021, nearly two-thirds target care to beneficiaries dually eligible for Medicare and Medicaid. Only one in five SNPs target care to beneficiaries with chronic and disabling conditions, and slightly less target care to beneficiaries requiring an institutional-level of care.

Most growth occurred in Dual Eligible SNPs

Enrollment in Special Needs Plans (SNPs) has more than doubled in the past decade.

  • The Medicare Modernization Act of 2003 established Medicare Special Needs Plans (SNPs) to provide coordinated care services to Medicare beneficiaries who are dually eligible for Medicare and Medicaid, require an institutional-level of care, and/or have a chronic and disabling condition.
  • SNP enrollment increased more than 2.5 times (164%) over the past decade. SNPs enrolled approximately 1.3 million beneficiaries in 2010 compared to 3.4 million in 2020.
  • The majority of beneficiaries – nearly 2.9 million, or 86 percent of those in a Special Needs Plan – are enrolled in a dual-eligible SNP (D-SNP). Approximately 11 percent and 3 percent of beneficiaries, respectively, are enrolled in a chronic condition SNP (C-SNP) and institutional SNP (I-SNP).

Source: CMS SNP Comprehensive Report, 2020 (March version).

Note: Dual eligibles describes individuals who receive both Medicare and Medicaid benefits. Medicare acts as the primary payer for most services, while Medicaid may help pay for premiums, cost-sharing, and benefits not covered by Medicare. Beneficiaries must be dually eligible for Medicare and Medicaid to enroll in a dual SNP (D-SNP).

Ninety-six percent of Medicare beneficiaries have access to Special Needs Plans (SNPs) in 2021.

  • Regardless of whether they meet enrollment criteria, including eligibility for both Medicare and Medicaid, need for institutional care, and presence of selected chronic conditions, approximately 96 percent of Medicare beneficiaries have access to a Special Needs Plan (SNP) in 2021.
  • Access to SNPs varies by type of plan:
  • In 2021, 92 percent of Medicare beneficiaries have access to a dual-eligible SNP if they meet eligibility criteria. This represents a 13 percentage-point increase from 2010.
  • The percentage of Medicare beneficiaries who could potentially access an institutional SNP increased by 26 points, from 48 percent in 2010 to 74 percent in 2021.
  • Access to chronic condition SNPs modestly declined over the past decade. In 2010, about 60 percent of the Medicare population could potentially enroll in a chronic condition SNP, compared to 58 percent in 2021.

Source: CMS State/County Penetration, and SNP Landscape Source File, 2010–2021. 

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

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