Medicare Advantage Stats by State

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The great debate: Original Medicare or Medicare Advantage? If you ask anyone at Caribou, we’ll tell you that one is not necessarily better than the other because it depends on the person enrolling. Their budget, health needs, and preferences all impact which Medicare option would be better for them. With that being said, Medicare Advantage plans are becoming increasingly popular. In fact, more than 28 million people were enrolled in a Medicare Advantage plan in 2022, accounting for nearly half (48 percent) of the eligible Medicare population. But, there are some states where Medicare Advantage plans that are more popular than others. As we look at how Medicare Advantage stats look across the United States, don’t forget that Medicare Advantage Open Enrollment is going on now until March 31st. If you have clients already on Medicare, now is the only time they can switch to a different Medicare Advantage plan option or drop their current Medicare Advantage plan option and switch to Original Medicare and a Medicare drug plan.

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States with the most Medicare Advantage enrollees

Puerto Rico has the highest percentage of Medicare Advantage enrollees, with 93 percent of Medicare beneficiaries enrolled in a Medicare Advantage plan. Next is Hawaii, with 59 percent of its Medicare-eligible population enrolled in a Medicare Advantage plan, and then Alabama with 57 percent. Across the whole country, 25 states had at least half of all Medicare-eligible residents enroll in a Medicare Advantage plan in 2022. Interestingly, the states with the lowest amount of Medicare Advantage enrollees were states that are mostly rural: Alaska, North Dakota, South Dakota, and Wyoming. Why? The likeliest reason is the lack of Medicare Advantage plan options. For example, in 2022 Alaska had two plan options and Wyoming had nine, so there’s a lack of choice. But that’s not the case for North Dakota and South Dakota; they had 23 and 25  plans available in 2022. While that’s certainly more than Alaska and Wyoming, it’s significantly less than other states. For example, in 2022 Texas had 337 Medicare Advantage plan options and New York had 280.

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To see the Medicare Advantage stats for each state, check out KFF’s interactive map here.

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Why do some states have higher Medicare Advantage enrollment rates?

The varying degree of Medicare Advantage penetration in states could be attributed to several factors. But as mentioned before, the likeliest reason is the number of options. Almost every state that had 50 percent or more of Medicare Advantage enrollees also had over 50 plan options. The states with 50 percent or more Medicare Advantage enrollees that did not have over 50 plan options were Rhode Island and Hawaii (both had 33.) Other factors that might impact why some states have more Medicare Advantage enrollees than others are costs and provider networks. For most Medicare-eligible adults, Original Medicare tends to be the more affordable option, but not always. The number of providers in a Medicare Advantage network, whether someone’s preferred provider is in-network, and the plan types also impact enrollment. For example, if a state only has high-deductible health plan options within Medicare Advantage plans, that could affect the number of enrollments (positively or negatively, depending on someone’s preference.)

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The cost of Medicare Advantage plans

As I mentioned earlier, the question “Is Medicare Original or Medicare Advantage better?” is arbitrary. It depends on the person and their situation. It also depends on if you’re only looking at premiums. If you’re only going by premiums, then most of the time Medicare Advantage is more affordable than Original Medicare. But it’s important to also consider the max out-of-pocket amount your client is exposed to in the plan they pick, their drug costs, copays, and coinsurance costs. When you consider all of that, more often than not Original Medicare ends up being the more “affordable” option. But even then it’s not so black and white. Let’s look at a real client scenario. 

Caribou conducted an interesting HealthPlanning Analysis where a client had Medicare Advantage plan options that were lower risk than Original Medicare. However, this is typically uncommon. So how did it happen? The out-of-pocket maximum in their county was only $900, which is unusually low for Medicare Advantage plans. This shows why it’s so important for everyone to participate in customized healthcare planning and not to make any general assumptions about healthcare costs — otherwise, you might introduce unnecessary financial risk.

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Final thoughts

These stats are helpful to know, especially since Medicare Advantage Open Enrollment is going on now until March 31st! This information, along with your clients’ health needs, preferences, and budget, can help you determine whether or not your Medicare clients should consider one of the following during Medicare Advantage Open Enrollment:

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• Switch to another Medicare Advantage Plan with or without drug coverage.
• Drop their Medicare Advantage Plan and go back to Original Medicare. They can also join a Medicare drug plan.

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And a great way to determine which plans are the optimal choice for an individual is to complete a customized HealthPlanning Analysis. That way you and your client aren’t left trying to make sense of dozens or even hundreds of plan options.

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