Rural enrollment in Medicare Advantage (MA) and other prepaid plans grew by 15% from December 2008 to December 2009, faster than the 10% national growth rate. Preferred provider organization plans drove the increased enrollment in MA plans in rural areas in 2009, while private fee-for-service (PFFS) plans continued to dominate the market with over 50% of enrollment. This landscape could change in 2010 as rural Medicare beneficiaries will experience a decline in PFFS availability, as some insurers have announced plans to pull their PFFS plans from the market.