Medicare Advantage (MA) enrollment continued to grow and premiums continued to decline in 2012 despite reductions in payment to the plans as mandated by the Affordable Care Act. Rural MA enrollees face higher premiums than their urban counterparts, and the average premium for rural MA beneficiaries fell to $48 per month in 2012 as compared to $52 per month in 2011.

Analysis of the zero premiums by plan in relationship to the plans charging a premium gives additional insights into the MA marketplace as faced by rural enrollees. Zero premium plans are less available in rural areas and are selected less often when they are available, which is a potential source of inequity between rural and urban areas.