The 2020 edition of the RUPRI Center's annual report on Medicare Advantage (MA) enrollment shows that as of March 2020, 36.1% of eligible Medicare beneficiaries were in an MA plan. The proportion of metropolitan enrollment (38.0%) is higher than that in nonmetropolitan counties (27.5%), but the rate of growth in enrollment has been higher in nonmetropolitan counties for the last three years.

Metropolitan MA enrollment in Health Maintenance Organization (HMO) plans remains strong (64.3% in 2020) but has declined since 2016 and is at its lowest level since at least 2009. The plurality of nonmetropolitan MA enrollment has been in local Preferred Provider Organization plans since 2012 (46.6% in 2020), but the percentage of nonmetropolitan enrollees in HMO plans has grown nearly every year since at least 2009. Enrollment in Private Fee-For-Service plans has continued to slide, reaching its lowest levels for both metropolitan and nonmetropolitan enrollees since at least 2009 (0.2% metropolitan and 1.2% nonmetropolitan in 2020).