October 2015 | Issue Brief
Medicare Advantage and Traditional Medicare: Is the
Balance Tipping?
Tricia Neuman, Giselle Casillas, Gretchen Jacobson
Executive Summary
A growing share of Medicare beneficiaries have been enrolling in Medicare Advantage plans over the past
decade, prompting some to question whether the balance between traditional Medicare and Medicare
Advantage could be on the verge of tipping. Since 2006, the share of Medicare beneficiaries enrolled in a
Medicare Advantage plan has nearly doubled, from 16 to 31 percent, but in some counties, the percentage is
much higher. In this brief, we look beneath national trends to examine Medicare Advantage penetration rates
and growth rates in counties across the country to assess the extent to which Medicare Advantage plans are
poised to cover more beneficiaries than traditional Medicare across the country.
Medicare Advantage penetration rates and patterns of growth vary widely across the country, reflecting the
diversity of markets and coverage decisions of beneficiaries. More specifically, we find:
• A small share (9%) of all Medicare beneficiaries lives in an area where at least 50 percent of
all beneficiaries are in a Medicare Advantage plan. Another 21 percent of all Medicare beneficiaries
are living in a county with 40-50 percent Medicare Advantage penetration. Beneficiaries living in areas
with high Medicare Advantage penetration (≥40%) tend to be clustered in more populated urban areas, in a
small number of states, and a small share of counties. For example, Medicare Advantage penetration is at
or above 50 percent in 2015 in just 4 percent of all counties.
• One-quarter of all Medicare beneficiaries (25%) lives in an area with relatively low Medicare
Advantage enrollment (<20%). Another 23 percent of Medicare beneficiaries live in a county where
Medicare Advantage penetration is below the national average (between 20 and 30%). Together, about half
of all Medicare beneficiaries nationwide live in a county where Medicare Advantage penetration is at or
below the national average, and where traditional Medicare covers the majority of beneficiaries.
• A small share of Medicare beneficiaries (13%) lives in an area where Medicare Advantage
penetration rates have grown relatively rapidly in recent years (≥ 15% average annual
growth rate since 2010, double the 7.5% national average). In contrast, half of all beneficiaries live
in an area where Medicare Advantage penetration rates have increased by less than 5 percent annually
since 2010, below the national average.
This analysis finds a small but growing share of the Medicare population living in a county with more
beneficiaries in Medicare Advantage plans than traditional Medicare. Even as Medicare Advantage enrollment
continues to rise, traditional Medicare is the primary source of coverage for the majority of beneficiaries in the
majority of counties across the country. While the balance between traditional Medicare and Medicare
Advantage may tip at some point in the future, it hasn’t happened yet.
Medicare Advantage Penetration Levels and Growth Rates: The Highs and Lows Across the Country 2
Figure 1
18%
17%
15%
14%
13% 13% 13%
16%
19%
22%
23%
24%
25%
27%
28%
30%
31%
82%
83%
85%
86%
87% 87% 87%
84%
81%
78%
77%
76%
75%
73%
72%
70%
69%
1999
2000
2001 2002 2003 2004
2005
2006 2007 2008
2009
2010 2011 2012 2013
2014
2015
Medicare Advantage
Traditional Medicare
NOTE: Includes MSAs, cost plans, demonstration plans, and Special Needs Plans as well as other Medicare Advantage plans.
SOURCE: Kaiser Family Foundation analysis of CMS Medicare Advantage enrollment files, 2008-2015, and MPR, “Tracking
Medicare Health and Prescription Drug Plans Monthly Report,” 1999-2007; enrollment numbers from March of the respective year,
with the exception of 2006, which is from April.
The share of Medicare beneficiaries enrolled in Medicare Advantage plans
increased from 24% to 31% between 2010 and 2015.
Number of
beneficiaries
(in millions):
6.9
6.8
6.2
5.6
5.3
5.3
5.6
6.8
8.4
9.7
10.5
11.1
11.9
13.1
14.4
15.7
16.8
Medicare Advantage Penetration Rates, 1999-2015
INTRODUCTION
Enrollment in Medicare Advantage plans nationwide is at an all-time high and continues to climb. Despite
concerns that payment reductions enacted by the Affordable Care Act would cause enrollment to decline,
Medicare Advantage enrollment has instead increased by 5.6 million, or 50 percent, since the law’s enactment.
1
This steady rise in Medicare Advantage enrollment has led some to question whether the balance between
traditional Medicare and private plans will soon tip, with more and more people enrolling in Medicare
Advantage plans.
2
With ongoing interest in the role and future of Medicare Advantage plans, this brief takes an in-depth look at
Medicare Advantage enrollment and growth rates, by county, metropolitan areas, and state. We used publicly
available Medicare Advantage State/County Penetration data from the Centers for Medicare and Medicaid
Services (CMS) to determine Medicare Advantage penetration rates in 2015, and growth rates between 2010
and 2015. More information about the data and methods used is included in the Methodology box at the end of
the brief. For the purpose of this analysis, we examined counties that had reached or exceeded 50 percent
Medicare Advantage penetration, but use the term “relatively high” Medicare Advantage enrollment to
incorporate counties in which at least 40 percent of beneficiaries are enrolled in a Medicare Advantage plan.
We define relatively low penetration counties as counties with less than 20 percent of beneficiaries in a
Medicare Advantage plan.
VARIATION IN MEDICARE ADVANTAGE PENETRATION RATES
• In 2015, nearly one-
third (31%) of Medicare
beneficiaries is enrolled
in a Medicare Advantage
plan, an increase from
nearly one-quarter
(24%) in 2010 (Figure
1). Nationally, traditional
Medicare continues to be
the primary source of
coverage for the Medicare
population, but Medicare
Advantage enrollment and
penetration has been on the
rise.
Medicare Advantage Penetration Levels and Growth Rates: The Highs and Lows Across the Country 3
Figure 2
22%
7%
1%
29%
18%
9%
25%
23%
18%
14%
22%
24%
7%
21%
31%
4%
9%
17%
Counties Medicare Beneficiaries Medicare Advantage Enrollees
≥ 50%
40 - 49%
30 - 39%
20 - 29%
10 - 19%
0 - 9%
Medicare
2015
SOURCE: Kaiser Family Foundation analysis of CMS MA State/County Penetration Files, March 2015.
A small share (9%) of Medicare beneficiaries, in 4% of US counties, live in an area
with more beneficiaries in Medicare Advantage than in traditional Medicare.
3,138
54 million
17 million
National Medicare
Advantage Penetration,
2015 = 31%
Figure 3
NOTE: The majority of private plan enrollees in Minnesota are enrolled in cost plans.
SOURCE: Kaiser Family Foundation analysis of CMS MA State/County Penetration Files, March 2015.
Counties with relatively high Medicare Advantage penetration tend to be in the
West, while low-penetration counties are mainly in the Midwest and rural areas.
0%-9% 10%-19% 20%-29% 30%-39% ≥40%
22% 29% 25% 14% 11%
Percent of counties:
National Medicare Advantage Penetration, 2015 = 31%
Medicare Advantage
Penetration, 2015:
• A small share (9%) of
Medicare beneficiaries
lives in an area where at
least half of all
beneficiaries are enrolled
in a Medicare Advantage
plan (Figure 2). Medicare
Advantage penetration is at or
above 50 percent in just 4
percent of counties. Another
21 percent of all Medicare
beneficiaries, in 7 percent of
counties, are living in a county
with 40-50 percent Medicare
Advantage penetration.
Beneficiaries living in areas
with high Medicare Advantage
penetration (≥40%) tend to be clustered in more populated urban areas because Medicare Advantage has
historically had a stronger presence in more populated, urban areas, and in a small number of states
(discussed below).
• Conversely, a quarter of
all Medicare beneficiaries
(25%) live in an area with
relatively low Medicare
Advantage penetration
(≤20%). In these counties,
Medicare Advantage plans
play a more minor role as the
vast majority of beneficiaries
in the county are in traditional
Medicare. Penetration rates
are at or below 20 percent in
half (51 percent) of all
counties.
• Counties with relatively
high Medicare Advantage
penetration rates tend to be in the West, but are also scattered across the Midwest,
Pennsylvania, New York, and Florida (Figure 3). Low penetration areas are mainly in the Midwest
and in rural states, but also in the Northeast and Mid-Atlantic regions. Even in regions with a strong
Medicare Advantage Penetration Levels and Growth Rates: The Highs and Lows Across the Country 4
Figure 4
6%
20%
35%
4%
17%
26%
26%
28%
30%
15%
24%
30%
27%
30%
21%
21%
31%
27%
21%
13%
9%
24%
16%
10%
12%
6%
3%
25%
8%
4%
7%
3%
2%
11%
4%
3%
Metropolitan Micropolitan Rural Metropolitan Micropolitan Rural
≥ 50%
40 - 49%
30 - 39%
20 - 29%
10 - 19%
0 - 9%
Rates, 2015
NOTE: High Medicare Advantage penetration was defined as penetration rates of 40% or more. A metropolitan statistical area is
defined as an urban area with a population of 50,000 or more. A micropolitan
statistical area is an urban area with a population of
at least 10,000 but no more than 50,000.
SOURCE: Kaiser Family Foundation analysis of CMS MA State/County Penetration Files, March 2015, and US Census Core based
statistical areas (CBSAs) and combined statistical areas (CSAs) file, February 2013.
Relatively high Medicare Advantage enrollment rates are more common in more
metropolitan areas than in other areas.
Counties Medicare Beneficiaries
1,097 669 1,372 42.7 million 6.4 million 4.4 million
National Medicare
Advantage Penetration,
2015 = 31%
Medicare Advantage presence, such as Southern California, there is often a range in Medicare Advantage
penetration across counties, reflecting local market conditions. For example, Medicare Advantage
penetration is 58 percent in San Bernardino County but 15 percent in Santa Barbara.
• Some of the variation in
Medicare Advantage
penetration across the
country reflects the
concentration of
Medicare beneficiaries
in urban areas, where
Medicare Advantage
plans have a stronger
presence (Figure 4).
While just over one-third
(35%) of counties are
classified as “metropolitan”
(with a population of
50,000 or more), 80
percent of Medicare
beneficiaries live in these
counties. A much larger share of metropolitan than micropolitan or rural counties have relatively high
Medicare Advantage penetration (19%, 9% and 5%, respectively).
• However, not all metropolitan areas have higher than average Medicare Advantage
penetration rates (See Table 1). While Medicare Advantage penetration tends to be well above
average in counties such as Los Angeles County (48%) and Miami-Dade (62%) in 2015, counties that
include the Baltimore, Annapolis, and Wilmington metropolitan areas have penetration rates of 10
percent or less in 2015. Penetration is near average in the counties that include Detroit, Atlanta, Seattle,
Milwaukee, and Chicago.
Medicare Advantage Penetration Levels and Growth Rates: The Highs and Lows Across the Country 5
Figure 5
24%
12%
9%
9%
Pennsylvania
8%
38%
NOTE: High Medicare Advantage penetration was defined as penetration rates of 40% or more, which included 11% of counties.
The 24 other states are: AL, AZ, CO, GA, HI, IA, ID, IL, IN, LA, MI, MN, MO, NC, NM, NV, OR, TN, TX, UT, VA, WA, WI, and WV.
SOURCE: Kaiser Family Foundation analysis of CMS MA State/County Penetration Files, March 2015.
Almost two
-thirds (62%) of Medicare Advantage enrollees who are living in
counties with high Medicare Advantage penetration are in 5 states in 2015.
California
Florida
New York
24 states
Ohio
Total number of Medicare Advantage enrollees in high penetration counties = 7 million
Figure 6
18%
17%
13%
10%
8%
7%
29%
25%
26%
23%
20%
18%
19%
22%
22%
23%
25%
23%
19%
19%
20%
19%
20%
22%
13%
13%
14%
17%
18%
21%
3%
4%
5%
7%
9%
9%
2010 2011 2012 2013 2014 2015
≥50%
40 - 49%
30 - 39%
20 - 29%
10 - 19%
0 - 9%
NOTE: High Medicare Advantage penetration was defined as penetration rates of 40% or more.
SOURCE: Kaiser Family Foundation analysis of CMS MA State/County Penetration Files, March 2010 - 2015.
The share of beneficiaries living in counties with high Medicare Advantage
penetration rates nearly doubled from 16% to 31% between 2010 and 2015.
Medicare
Advantage
Penetration
Rates
31%
16%
National Medicare Advantage
Penetration, 2015 = 31%
25%
47%
• Almost two-thirds of
Medicare Advantage
enrollees who live in
counties with relatively
high Medicare Advantage
penetration are clustered
in five states (Figure 5).
California alone accounts for
about one-quarter (24%) of all
Medicare Advantage enrollees
living in high-penetration
areas, in large part due to high
enrollment rates in southern
California, including Los
Angeles, Orange, Riverside,
San Bernardino, and San
Diego counties (Table 2).
Other states in which high-penetration counties are clustered include Florida, New York, Ohio and
Pennsylvania.
CHANGE IN MEDICARE ADVANTAGE PENETRATION OVER TIME
• Between 2010 and 2015,
the share of beneficiaries
living in counties with
more than 50 percent
Medicare Advantage
penetration has tripled
from 3 percent to 9
percent (Figure 6). Overall,
the share of beneficiaries
living in relatively high
Medicare Advantage
penetration areas (≥ 40%) has
nearly doubled, from 16
percent to 31 percent during
this period. Conversely, the
share of beneficiaries living in
areas with relatively low
Medicare Advantage penetration has declined.
Medicare Advantage Penetration Levels and Growth Rates: The Highs and Lows Across the Country 6
Figure 7
16%
13%
12%
20%
37%
44%
15%
16%
16%
12%
12%
11%
14%
10%
7%
23%
13%
9%
Counties Beneficiaries Medicare Advantage Enrollees
≥15%
10% to 14.9%
7.5% - 9.9%
5% to 7.49%
1% to 4.9%
<1%
NOTE: Excludes 51 counties with Medicare Advantage enrollment in only 1 year. Percents
may not total 100 due to rounding.
SOURCE: Kaiser Family Foundation analysis of CMS MA State/County Penetration Files, March 2010 - 2015.
Nearly one in four Medicare beneficiaries live in areas that experienced rapid
growth in Medicare Advantage enrollment between 2010 and 2015.
3,141 54 million 17 million
Medicare
Advantage Average
Annual Growth
Rates, 2010 - 2015
National Average Annual Growth Rate in Medicare Advantage Penetration, 2010-2015 =
7.5%
2015 =
Figure 8
NOTE: Excludes 51 counties with Medicare Advantage enrollment in only 1 year.
SOURCE: Kaiser Family Foundation analysis of CMS MA State/County Penetration Files, March 2010 - 2015.
Many counties in the Midwest and South experienced higher than average growth
in Medicare Advantage penetration rates between 2010 and 2015.
N/A <1% 1 - 4.9% 5 - 7.49% 7.5 – 9.9% 10 – 14.9% ≥15%
<1% 16% 20% 15% 12% 14% 23%
<1% 13% 37% 16% 12% 10% 13%
Percent of counties:
Percent of beneficiaries:
National Average Annual Growth Rate in Medicare Advantage
Penetration, 2010-2015 = 7.5%
Average Annual Growth
Rate, 2010-2015:
• About 13 percent of
Medicare beneficiaries
live in an area where
Medicare Advantage
penetration rates have
grown very rapidly in
recent years (defined as ≥
15% average annual
growth rate since 2010) –
double the 7.5 percent
national average (Figure
7). Another 5.1 million
beneficiaries (10 percent) of all
Medicare beneficiaries live in
an area that experienced
average annual growth in
Medicare Advantage
enrollment of 10 to 15 percent between 2010 and 2015.
o More than three-quarters (77%) of the 1.5 million Medicare Advantage enrollees who live in
counties that experienced high growth (≥ 15%) in Medicare Advantage penetration between 2010
and 2015 reside in four states: Michigan, Illinois, North Carolina and Texas. These high-growth
counties tend to have below average Medicare Advantage penetration in 2015 (averaging 24%).
• About half of all
beneficiaries live in
counties where Medicare
Advantage penetration
increased by less than 5
percent annually between
2010 and 2015. These
slower-growth counties tend
to have above average
Medicare Advantage
penetration rates in 2015
(averaging 43% in 2015).
• The average annual
growth in Medicare
Advantage penetration
between 2010 and 2015
varied widely across the
country (Figure 8). The average annual growth in Medicare Advantage penetration between 2010 to
2015 ranges from a high of 34 percent (Lake County, IN and Lake County, IL) to a low of negative 5 percent
in Santa Barbara County, California (Tables 4 and 5).
Medicare Advantage Penetration Levels and Growth Rates: The Highs and Lows Across the Country 7
DISCUSSION
Medicare Advantage has become a larger part of the Medicare program over the past several years. Despite
concerns that enrollment would drop in response to payment reductions included in the Affordable Care Act of
2010, enrollment has climbed steadily over the past five years, and is projected to continue to rise over the next
decade.
3
Medicare Advantage enrollment has increased across the country, although penetration and growth
rates have been much higher in some parts of the country than others. Some areas have experienced more
rapid growth than others in the past few years which may be due to a number of factors, such as market
conditions, consumer preferences, and payment rates.
All signs suggest Medicare Advantage penetration will continue to rise but unevenly across the country. As of
now, just nine percent of beneficiaries live in an area where more beneficiaries are enrolled in Medicare
Advantage plans than traditional Medicare, and it seems likely this share will increase. Nonetheless, for the
vast majority of beneficiaries, traditional Medicare is likely to remain the primary source of coverage for the
foreseeable future. While the balance between traditional Medicare and Medicare Advantage may tip in the
future, it hasn’t happened yet.
The authors appreciate the informative and helpful comments that Marsha Gold, Sc.D., Senior
Fellow Emeritus at Mathematica Policy Research, Inc. provided on an earlier draft of this brief.
Medicare Advantage Penetration Levels and Growth Rates: The Highs and Lows Across the Country 8
Methodology
Most of the data used in this analysis come from the Centers for Medicare and Medicaid Services (CMS) MA
State/County Penetration file for March of 2015. These files contain the number of Medicare beneficiaries and
Medicare Advantage enrollees at the county level. Medicare Advantage enrollment includes data for all plan
types, including Local and Regional CCP, MSA, PFFS, demonstrations, national PACE, cost, and employer-
sponsored plans. Data for counties with 10 or fewer enrollees are not included due to privacy laws and are thus
not included in this analysis. The analysis also uses the Census Core based statistical areas (CBSAs) and
combined statistical areas (CSAs) file, February 2013 to examine differences in penetration and growth rates in
metropolitan, micropolitan, and rural areas.
To examine the extent to which Medicare Advantage penetration and growth rates are associated with county-
level market and demographic characteristics, correlations were calculated separately between Medicare
Advantage penetration in 2015 and average annual growth rates and the following variables: average
traditional Medicare spending in a county; Medicare Advantage risk-adjusted rebate amounts; percent of
Medicare Advantage enrollees in employer-sponsored (group) plans; percent of Medicare Advantage enrollees
in Preferred Provider Organizations (PPOs); percent of Medicare Advantage enrollees in Health Maintenance
Organizations (HMOs); percent of seniors with incomes below the poverty threshold; percent of county
residents with incomes below the poverty threshold; median household income; share and number of Medicare
beneficiaries that were new to Medicare; average age of Medicare beneficiaries 65 or older; average age of all
Medicare beneficiaries; share of Medicare beneficiaries who were disabled; year of the oldest active Medicare
Advantage plan; rural county designation; and Medicare Advantage payment quartiles.
All correlation coefficients indicated relatively weak relationships.
Correlation coefficients were less than 10 percent (positive or negative) when testing the relationship between
Medicare Advantage penetration in 2015 and the following variables: Medicare Advantage payment quartiles;
average beneficiary age; share of beneficiaries that were new to Medicare in 2015; local poverty rates; the share
of beneficiaries who were disabled; and the percent of Medicare Advantage enrollees in employer-sponsored
(group) plans. The correlations between Medicare Advantage penetration in 2015 and the percent of Medicare
Advantage enrollees in PPOs and between Medicare Advantage penetration in 2015 and the average traditional
Medicare spending in a county were each negative 18 percent. More moderate correlation coefficients were
observed between 2015 penetration rates and the following variables: number of new Medicare beneficiaries
(23%); rural county designation (-27%); risk-adjusted Medicare Advantage rebate amounts (30%); the percent
of Medicare Advantage enrollees in HMOs (38%); and year of the oldest active Medicare Advantage plan (-
40%).
Correlations were similarly weak (less than positive or negative 10%) between the Medicare Advantage annual
penetration growth rate in a given county between 2010 and 2015 and the following county-based variables:
share of beneficiaries new to Medicare; average beneficiary age; Medicare Advantage payment quartiles;
percent of Medicare Advantage enrollees in Special Needs Plans; percent of Medicare Advantage enrollees in
employer-sponsored (group) plans; share of beneficiaries who were disabled; rural county designation; year of
the oldest active Medicare Advantage plan; and average traditional Medicare spending in a county. The
relationship between growth rates and the remaining variables – percent of Medicare Advantage enrollees in
HMOs, percent of Medicare Advantage enrollees in PPOs, risk-adjusted Medicare Advantage rebate amounts,
and local poverty rates – did not exceed 18 percent.
Medicare Advantage Penetration Levels and Growth Rates: The Highs and Lows Across the Country 9
Appendix
Table 1: The 5 Largest Counties by Penetration Group, 2015
State
County
Medicare
Beneficiaries, 2015
Medicare Advantage
Penetration Rate,
2015
Average Annual
Medicare Advantage
Penetration Growth
Rate, 2010 - 2015
All Counties MA Penetration > 50
Florida Miami-Dade 420,702 62% 4%
California Riverside 321,249 57% 4%
Florida Broward 283,971 54% 3%
California San Bernardino 257,419 58% 4%
Pennsylvania Allegheny 247,434 62% 1%
All Counties MA Penetration 40- 50%
California Los Angeles 1,344,850 48% 5%
Arizona Maricopa 587,995 43% 0%
California San Diego 463,635 47% 3%
California Orange 443,197 47% 3%
New York Kings 340,846 41% 4%
All Counties MA Penetration 30- 40%
Texas Harris 465,027 39% 7%
Michigan Wayne 312,564 32% 16%
Nevada Clark 294,530 39% 2%
Florida Palm Beach 288,386 37% 4%
Texas Dallas 286,947 30% 9%
All Counties MA Penetration 20- 30%
Illinois Cook 769,309 23% 20%
New York Suffolk 266,811 21% 5%
Massachusetts Middlesex 248,347 23% 0%
New York Nassau 244,636 24% 4%
New York Westchester 162,885 24% 7%
All Counties MA Penetration 10- 20%
New Jersey Bergen 158,800 14% 6%
New Jersey Ocean 142,923 18% 5%
Maryland Montgomery 142,262 10% 5%
Massachusetts Essex 142,201 19% 2%
Illinois DuPage 138,544 17% 29%
All Counties MA Penetration 0- 10%
Maryland Baltimore 146,830 9% 0%
Delaware New Castle 89,223 10% 17%
Maryland Anne Arundel 83,847 6% -1%
New Hampshire Hillsborough 69,740 8% 4%
California Monterey 57,418 2% 10%
SOURCE: Kaiser Family Foundation analysis of CMS MA State/County Penetration Files, March 2015.
Medicare Advantage Penetration Levels and Growth Rates: The Highs and Lows Across the Country 10
Table 2: The 50 Largest Counties with the Highest Medicare Advantage Penetration Rate, 2015
– Sorted high to low by Medicare Advantage Penetration Rate, 2015
State
County
Medicare
Beneficiaries, 2015
Medicare Advantage
Penetration Rate,
2015
Average Annual
Medicare Advantage
Penetration Growth
Rate, 2010 - 2015
Pennsylvania
Westmoreland
84,964
66%
1%
New York
Monroe
142,272
63%
1%
Pennsylvania
Allegheny
247,434
62%
1%
Florida
Miami-Dade
420,702
62%
4%
Oregon
Clackamas
71,193
61%
1%
California
San Bernardino
257,419
58%
4%
Oregon
Multnomah
110,238
58%
2%
Oregon
Marion
55,898
58%
1%
Oregon
Washington
74,146
57%
2%
California
Riverside
321,249
57%
4%
Louisiana
Jefferson
79,016
57%
3%
New York
Erie
185,347
56%
2%
Minnesota
Dakota
57,488
55%
5%
Minnesota
Hennepin
174,325
55%
4%
Minnesota
Ramsey
81,420
55%
4%
Colorado
Jefferson
92,064
54%
1%
Washington
Clark
73,150
54%
3%
New York
Bronx
187,059
54%
5%
Florida
Broward
283,971
54%
3%
Florida
Pasco
113,780
53%
4%
Colorado
Adams
53,543
53%
1%
North Carolina
Forsyth
63,689
53%
3%
Ohio
Stark
78,836
52%
3%
Florida
Hernando
52,948
52%
5%
Ohio
Summit
101,919
52%
5%
Ohio
Mahoning
52,328
51%
4%
Oregon
Lane
73,866
51%
2%
North Carolina
Guilford
84,408
50%
7%
Michigan
Kent
96,075
50%
9%
Colorado
Denver
83,249
50%
2%
New Mexico
Bernalillo
111,188
49%
3%
Ohio
Montgomery
104,217
49%
4%
Texas
El Paso
113,527
49%
9%
Ohio
Franklin
162,974
48%
5%
Texas
Nueces
53,651
48%
5%
Hawaii
Honolulu
165,753
48%
3%
California
Los Angeles
1,344,850
48%
5%
California
Orange
443,197
47%
3%
Pennsylvania
Dauphin
50,092
47%
3%
Florida
Polk
133,749
47%
7%
Florida
Hillsborough
202,003
47%
4%
California
San Diego
463,635
47%
3%
Idaho
Ada
62,962
47%
3%
Arizona
Pima
187,732
47%
2%
Florida
Pinellas
219,663
46%
5%
California
Contra Costa
175,189
46%
1%
Florida
Volusia
128,192
46%
4%
Louisiana
Orleans
55,895
46%
4%
Washington
Snohomish
106,900
45%
5%
California
Placer
71,991
45%
0%
NOTE: Only counties with more than 50,000 Medicare beneficiaries are included.
SOURCE: Kaiser Family Foundation analysis of CMS MA State/County Penetration Files, March 2015.
Medicare Advantage Penetration Levels and Growth Rates: The Highs and Lows Across the Country 11
Table 3: The 50 Largest Counties with the Lowest Medicare Advantage Penetration Rate, 2015
– Sorted low to high by Medicare Advantage Penetration Rate, 2015
State
County
Medicare
Beneficiaries, 2015
Medicare Advantage
Penetration Rate,
2015
Average Annual
Medicare Advantage
Penetration Growth
Rate, 2010 - 2015
California
Monterey
57,418
2%
10%
Delaware
Sussex
56,315
5%
20%
Maryland
Anne Arundel
83,847
6%
-1%
New Jersey
Atlantic
51,231
8%
0%
New Hampshire
Rockingham
55,764
8%
5%
New Hampshire
Hillsborough
69,740
8%
4%
Maryland
Baltimore
146,830
9%
0%
Delaware
New Castle
89,223
10%
17%
Maryland
Montgomery
142,262
10%
5%
New Jersey
Morris
82,111
10%
2%
Massachusetts
Barnstable
68,530
11%
4%
Illinois
Lake
97,077
12%
34%
California
San Luis Obispo
54,536
12%
-1%
Virginia
Fairfax
132,787
12%
5%
District of Columbia
Washington
87,367
13%
6%
Maryland
Baltimore City
96,704
13%
-1%
California
Tulare
56,553
13%
5%
New Jersey
Monmouth
111,656
13%
4%
New Jersey
Mercer
62,089
14%
3%
New Jersey
Bergen
158,800
14%
6%
Maryland
Prince George's
113,587
14%
4%
Massachusetts
Plymouth
96,905
14%
0%
California
Santa Barbara
69,527
15%
-5%
Indiana
Lake
85,379
15%
34%
New Jersey
Middlesex
122,907
15%
6%
Massachusetts
Bristol
110,259
15%
3%
Virginia
Va. Beach City
62,735
16%
7%
Alabama
Madison
57,237
16%
8%
South Carolina
Horry
72,635
16%
11%
New Jersey
Burlington
80,871
16%
0%
New York
Orange
56,986
17%
13%
Illinois
DuPage
138,544
17%
29%
New Jersey
Camden
88,147
18%
1%
New York
Dutchess
53,869
18%
10%
New Jersey
Ocean
142,923
18%
5%
South Carolina
Charleston
63,423
18%
11%
New York
Rockland
53,270
18%
6%
Connecticut
New London
50,507
18%
12%
Arkansas
Pulaski
69,860
18%
9%
Massachusetts
Norfolk
119,955
18%
-1%
New Jersey
Passaic
76,897
18%
8%
Massachusetts
Essex
142,201
19%
2%
Iowa
Polk
65,437
19%
4%
New Jersey
Union
80,955
19%
6%
Kansas
Sedgwick
78,223
19%
7%
Illinois
Will
89,668
19%
33%
South Carolina
Richland
56,264
19%
6%
Illinois
Kane
66,644
20%
21%
Florida
Collier
84,003
21%
13%
New York
Suffolk
266,811
21%
5%
NOTE: Only counties with more than 50,000 Medicare beneficiaries are included.
SOURCE: Kaiser Family Foundation analysis of CMS MA State/County Penetration Files, March 2015.
Medicare Advantage Penetration Levels and Growth Rates: The Highs and Lows Across the Country 12
Table 4: The 50 Largest Counties with the Highest Medicare Advantage Average Annual Growth, 2010 –
2015 – Sorted high to low by Average Annual Medicare Advantage Penetration Growth Rate
State
County
Medicare
Beneficiaries, 2015
Medicare Advantage
Penetration Rate,
2015
Average Annual
Medicare Advantage
Penetration Growth
Rate, 2010 - 2015
Indiana
Lake
85,379
15%
34%
Illinois
Lake
97,077
12%
34%
Illinois
Will
89,668
19%
33%
Illinois
DuPage
138,544
17%
29%
Texas
Hidalgo
90,690
35%
25%
Michigan
Washtenaw
51,064
28%
23%
Illinois
Kane
66,644
20%
21%
Illinois
Cook
769,309
23%
20%
Delaware
Sussex
56,315
5%
20%
Michigan
Macomb
160,039
31%
19%
Michigan
Oakland
217,794
31%
18%
Texas
Travis
113,201
25%
17%
Delaware
New Castle
89,223
10%
17%
Texas
Cameron
55,294
38%
16%
Michigan
Wayne
312,564
32%
16%
Florida
Lake
86,782
32%
15%
North Carolina
Mecklenburg
119,517
31%
15%
Florida
Citrus
51,772
32%
14%
North Carolina
Wake
117,475
31%
14%
Michigan
Genesee
83,653
35%
14%
Maine
Cumberland
56,599
28%
13%
Florida
Collier
84,003
21%
13%
New York
Orange
56,986
17%
13%
Florida
Sumter
59,153
32%
13%
New York
Onondaga
87,400
36%
12%
Connecticut
New London
50,507
18%
12%
South Carolina
Charleston
63,423
18%
11%
South Carolina
Horry
72,635
16%
11%
Florida
Sarasota
123,056
26%
11%
California
Monterey
57,418
2%
10%
New Jersey
Hudson
77,792
22%
10%
Texas
Denton
73,775
28%
10%
Massachusetts
Suffolk
100,001
22%
10%
Indiana
Marion
133,993
27%
10%
Florida
Escambia
62,360
28%
10%
New York
Dutchess
53,869
18%
10%
Illinois
Madison
50,492
30%
10%
North Carolina
Buncombe
53,135
25%
10%
Florida
Duval
139,652
31%
10%
Texas
El Paso
113,527
49%
9%
Wisconsin
Milwaukee
145,125
41%
9%
Texas
Fort Bend
67,623
33%
9%
Florida
Marion
101,107
39%
9%
Connecticut
Hartford
160,972
29%
9%
Arkansas
Pulaski
69,860
18%
9%
Georgia
Fulton
118,697
36%
9%
Georgia
DeKalb
89,849
39%
9%
Florida
Charlotte
58,326
31%
9%
Georgia
Gwinnett
85,751
35%
9%
Tennessee
Shelby
135,639
26%
9%
NOTE: Only counties with more than 50,000 Medicare beneficiaries are included.
SOURCE: Kaiser Family Foundation analysis of CMS MA State/County Penetration Files, March 2015.
Medicare Advantage Penetration Levels and Growth Rates: The Highs and Lows Across the Country 13
Table 5: The 50 Largest Counties with the Lowest Medicare Advantage Average Annual Growth, 2010 –
2015 – Sorted low to high by Average Annual Medicare Advantage Penetration Growth Rate
State
County
Medicare
Beneficiaries, 2015
Medicare Advantage
Penetration Rate,
2015
Average Annual
Medicare Advantage
Penetration Growth
Rate, 2010 - 2015
California
Santa Barbara
69,527
15%
-5%
Pennsylvania
Montgomery
146,236
27%
-3%
California
Solano
67,849
39%
-2%
Pennsylvania
Chester
82,420
24%
-2%
Maryland
Anne Arundel
83,847
6%
-1%
Maryland
Baltimore City
96,704
13%
-1%
Pennsylvania
Bucks
121,609
32%
-1%
Pennsylvania
Delaware
98,396
28%
-1%
California
San Luis Obispo
54,536
12%
-1%
Massachusetts
Norfolk
119,955
18%
-1%
Massachusetts
Worcester
140,243
35%
0%
Arizona
Pinal
66,374
37%
0%
New Jersey
Burlington
80,871
16%
0%
New Jersey
Atlantic
51,231
8%
0%
California
Placer
71,991
45%
0%
Maryland
Baltimore
146,830
9%
0%
Massachusetts
Middlesex
248,347
23%
0%
Oklahoma
Tulsa
100,323
30%
0%
Arizona
Maricopa
587,995
43%
0%
Rhode Island
Providence
111,469
37%
0%
Pennsylvania
Philadelphia
245,320
43%
0%
Massachusetts
Plymouth
96,905
14%
0%
California
Contra Costa
175,189
46%
1%
Oregon
Marion
55,898
58%
1%
California
Marin
53,125
36%
1%
California
San Mateo
116,237
44%
1%
Pennsylvania
Westmoreland
84,964
66%
1%
California
Kern
104,434
36%
1%
California
Alameda
218,647
42%
1%
New York
Richmond
80,747
40%
1%
New York
Monroe
142,272
63%
1%
Pennsylvania
Allegheny
247,434
62%
1%
New Jersey
Camden
88,147
18%
1%
Colorado
Adams
53,543
53%
1%
Oregon
Clackamas
71,193
61%
1%
California
Sacramento
226,661
45%
1%
Colorado
Jefferson
92,064
54%
1%
Alabama
Jefferson
123,132
43%
1%
Pennsylvania
Erie
54,310
45%
1%
Colorado
Denver
83,249
50%
2%
Nevada
Clark
294,530
39%
2%
Arizona
Pima
187,732
47%
2%
Colorado
Arapahoe
80,342
44%
2%
Pennsylvania
Berks
77,402
34%
2%
Oregon
Multnomah
110,238
58%
2%
Oregon
Washington
74,146
57%
2%
New York
Erie
185,347
56%
2%
Massachusetts
Essex
142,201
19%
2%
California
Fresno
124,905
30%
2%
California
Ventura
129,251
29%
2%
NOTE: Only counties with more than 50,000 Medicare beneficiaries are included.
SOURCE: Kaiser Family Foundation analysis of CMS MA State/County Penetration Files, March 2015.
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Endnotes
1
G. Jacobson, A. Damico, T. Neuman, and M. Gold. “Medicare Advantage 2015 Spotlight: Enrollment Market Update.” Washington DC:
Henry J. Kaiser Family Foundation, June 2015. Available at: http://kff.org/medicare/issue-brief/medicare-advantage-2015-spotlight-
enrollment-market-update/
2
A. Frakt. “Gingrich’s Correct Prediction About Medicare’s Future.” The New York Times, July, 2014. Available at:
http://www.nytimes.com/2014/07/08/upshot/gingrichs-correct-prediction-about-medicares-future.html
3
Congressional Budget Office. “March 2015 Medicare Baseline.” March 9, 2015. Available at:
https://www.cbo.gov/sites/default/files/cbofiles/attachments/44205-2015-03-Medicare.pdf