New Policy Brief Analyzes Medicare Advantage Participation Across Geographies

New from the RUPRI Center for Rural Health Policy Analysis

Distributional Analysis of Variation in Medicare Advantage Participation Within and Between Metropolitan, Micropolitan, and Noncore Counties
Dan Shane, PhD; Ufuoma Ejughemre, MD, MSc; Fred Ullrich, BA; Keith Mueller, PhD

This policy brief uses county-level information from 2017-2022 on population and MA plans to analyze relative MA participation rates by geographic classification. We use Urban Influence Codes to split counties into metropolitan, micropolitan, and noncore categories. Within each geographic classification, we order counties into quintiles by MA penetration rate (MA enrollees / Medicare-eligible enrollees) with the lowest 20% of county penetration rates comprising the first quintile. We find consistent growth in the median number of plans and median enrollment across all geographic classifications and all quintiles between 2017 and 2022, with slightly higher growth in micropolitan and noncore counties. We also find that growth rates were consistently higher in the lowest quintiles (lowest penetration rates) in each geographic classification. However, the absolute differences in median number of plans and median enrollment between these lowest-ranked counties and higher ranking counties in MA participation remained the same.

Key Findings

• From 2017 through 2022, growth (measured as percent increase) in the number of MA plans and MA enrollment rates was higher in noncore and micropolitan counties than in metropolitan counties, but metropolitan enrollment rates remained higher than nonmetropolitan enrollment rates. The median number of MA plans in metropolitan counties is higher than that in micropolitan counties which is higher than the median number of plans in noncore counties.
• Within each rural-urban classification, percent growth in MA penetration rates, plans, and enrollment has been highest in counties with the lowest participation rates in 2017.

Population size is closely tied to higher participation rates both within and across geographic classifications, with the important caveat that micropolitan and noncore counties with higher MA participation exceed rates that population only would suggest.

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