The Changing Landscape of Medicare Advantage in Rural America

In 2024, 46.2 percent of eligible rural Medicare beneficiaries and 53.7 percent of eligible urban beneficiaries were enrolled in a Medicare Advantage (MA) plan. Although both rural and urban MA enrollment growth rates have both steadily increased for 20 years, since 2020 the rate of growth in rural counties has been nearly twice that of urban counties. This rapidly changing landscape has caught some healthcare providers off guard and it is clear that rural health policy will benefit from a broader understanding of the organizations behind MA plans and the characteristics of beneficiaries joining those plans. This project will describe the evolving MA marketplace.

This project will delve more deeply into the types of firms sponsoring MA plans. The focus will be on geographic service areas and firm characteristics including profit status and ownership types. Part of the project's focus will be on the small number of firms with the largest shares of enrollment (e.g., UnitedHealthcare, Humana, and CVS Health). We expect variation across regions, and within regions across counties. We also expect some enrollment growth in regional MA plans owned by health systems, such as Sanford Health MA plan, Intermountain Health (Select Health), and Essentia Health (Essentia Care).

An additional project focus will be on rural beneficiaries enrolling in MA plans. That focus will include tracking enrollment in employer group or union-sponsored MA plans, and increased enrollment in Special Needs Plans (SNPs).