Rural enrollment in Medicare Advantage continues to grow rapidly in 2008, led by private fee-for-service plans.

Enrollment of rural beneficiaries into Medicare Advantage (MA) plans has more than quadrupled since the inception of the MA program at the beginning of 2006 and increased 35% in the last year. However, as a percent of all beneficiaries, the enrollment rate in rural areas (11.8%) remains well below the national enrollment rate (21.8%) (Tables 1 and 2). The tremendous growth in rural MA plans over the past two and a half years is mostly attributed to the spread of private fee-for-service (PFFS) plans across the country, which now account for 58% of rural Medicare eligibles (Figure 1). Compared to PFFS plans, health maintenance organizations (HMOs) have lower enrollment in rural areas (3.1%) but higher enrollment in urban areas (17.7%) (Figure 2).