February 2010: a dramatic shift away from private fee-for-service plans in rural Medicare Advantage enrollment.

In a reversal of recent trends, private fee-for-service (PFFS) enrollment fell dramatically in rural areas in early 2010. As a result, Medicare Advantage (MA) enrollment in rural areas (excluding other prepaid plans) fell slightly in early 2010 for the first time in years. The dramatic drop in PFFS enrollment was offset by increases in enrollment in preferred provider organization (PPO) and health maintenance organization (HMO) plans. Although PFFS enrollment has driven the rapid growth of the MA program in recent years, particularly in rural areas, the MA market share held by PFFS plans in rural areas fell significantly from 52% in December 2009 to 38% in February 2010. The decline was driven by some plans leaving the market and by underutilized and duplicative plans consolidating; factors contributing to this trend include slow growth in payment rates, legislative changes requiring PFFS plans to form provider networks by 2011, and significant increases in beneficiary premiums. Nationwide, enrollment in PPO and HMO plans grew, offsetting the decline in PFFS enrollment and contributing to a slight growth in total MA enrollment in 2010.