March 2011: growth in PPOs dominates the rural MA market in 2011.

Medicare Advantage (MA) enrollment has changed dramatically in 2011 as enrollment has shifted from private fee-for-service (PFFS) plans into preferred provider organization (PPO) plans. PFFS plans dominated the growth of the rural MA market from 2005 to 2010; however, a significant number of PFFS plans have left the market due to legislative changes that required plans to provide protections for beneficiaries in certain areas of the country. As a result, the number of PFFS plans offered fell from 413 plans in 2010 to 220 plans in 2011 and rural Medicare beneficiaries have fewer options for MA health insurance coverage in 2011 — an average of 16 MA plans to choose from, compared with 24 plans on average in 2010. While the drop in PFFS plans has led to a decline in PFFS enrollment, rural MA enrollment has continued to grow in the last year due to sizeable increases in PPO and health maintenance organization (HMO) enrollment of 306,309 enrollees and 69,900 enrollees, respectively.