The 2019 edition of the RUPRI Center's annual report on Medicare Advantage (MA) enrollment shows that as of March 2019, 35.0% of eligible Medicare beneficiaries were in an MA plan. The proportion of metropolitan enrollment (37.0%) is higher than that in nonmetropolitan counties (25.6%), but the rate of growth in enrollment has been higher in nonmetropolitan counties for the past two years.

Although well over half of metropolitan MA enrollment has been in Health Maintenance Organization (HMO) plans during the past 10 years (65.0% in 2019), since 2012 the plurality of nonmetropolitan MA enrollment has been in local Preferred Provider Organization (PPO) plans. However, nonmetropolitan enrollment in both HMO plans and local PPOs has grown consistently since 2009 (2019 enrollment: 32.7% and 45.2%, respectively). Growth in these two plan types has come largely at the expense of nonmetropolitan Private Fee for Service plans, which accounted for 54.5% of nonmetropolitan MA enrollment in 2009 but only 2.0% by 2019.