SCALE Healthcare Leadership Conference on October 18, 2023 at 8:00 AM-6:00 PM. Click here to register
Member Login

Medicare Data
Hub

Dashboard Overview

Medicare Enrollment

Enrollment in Medicare is projected to increase an average of 1.5 million beneficiaries per year from 2021 to 2029.

Source: Centers for Medicare and Medicaid Services, Program Statistics, 1965–2018, and Congressional Budget Office, Medicare Baseline, March 2020.

Medicare Financing, Spending, and Affordability

Medicare spending is projected to nearly double between 2019 and 2029.

Source: National Health Expenditure Accounts, by type of service and source of funds, 1960–2018 and Congressional Budget Office, Medicare Baseline, March 2020.

Focusing on Quality Healthcare

Capitated payments to Medicare Advantage and Part D plans comprise more than two-fifths of federal spending for Medicare

Total Medicare Benefits, 2020: $814 Billion

Source: Congressional Budget Office, Medicare Baseline, March 2020.
Note: Benefits are net of recoveries.

Supplementary Medical Insurance Cost-Sharing and Premium Amount

All Medicare beneficiaries are required to pay the Part B premium, in addition to any premium for their Medicare Advantage or Part D plan.

Source: 2020 Medicare Trustees Report, Supplementary Medical Insurance Cost‑Sharing and Premium Amount, 1967–2029.
Note: Not adjusted for inflation.

Medicare spending per beneficiary is projected to grow significantly

Federal Medicare spending per beneficiary is projected to increase nearly 60 percent from 2019 to 2029.

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.

  • <1%–9%
  • 10%–19%
  • 20%–29%
  • 30%–39%
  • 40%–67%
  • No Medicare Advantage enrollment, or missing data
  • 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.

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.

  • <1%–9%
  • 10%–19%
  • 20%–29%
  • 30%–39%
  • 40%–67%
  • No Medicare Advantage enrollment, or missing data
  • 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.

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. 

Most Medicare Advantage (MA) plans provide prescription drug coverage.

Average Medicare Advantage premiums fell by approximately 40 percent between 2010 and 2020.

Weighted by plan enrollment

  • Average total MA plan premiums – which cover costs associated with both Part C and Part D components – decreased by $4 between 2019 and 2020, a 14 percent reduction.
  • Despite fluctuation over the past decade, average MA total plan premiums declined by 40 percent between 2010 and 2020.

Source: CMS Plan and Premium Information for Medicare Plans Offering Part D Coverage, 2010–2020.

Notes: Data represent average plan premiums weighted by plan enrollment and are not adjusted by inflation. Data do not include Special Needs Plans, employer-sponsored plans, Part B–only plans, or plans not offering a Part D drug benefit. The Part C premium covers Medicare medical and hospital care; the Part D premium is a total (basic and supplemental) premium.

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.

Source: CMS SNP Landscape Source File, 2010–2021. 

Note: Employer-sponsored plans, demonstrations, and plans under sanction are excluded from SNP counts.