Medicare Benefit 2025 Highlight: A First Have a look at Plan Choices

During the last decade, Medicare Benefit, the personal plan various to conventional Medicare, has taken on a distinguished function within the Medicare program. In 2024, almost 33 million Medicare beneficiaries are enrolled in a Medicare Benefit plan, greater than half, or 54%, of the eligible Medicare inhabitants.

Regardless of considerations that modifications to the payment formula and Health-caremax”>increased utilization would impression the variety of Medicare Benefit plans supplied in 2025, the Medicare Benefit market seems to be comparatively steady. Whereas Medicare Benefit insurers have made some changes of their choices, the common Medicare beneficiary has a alternative of greater than 30 Medicare Benefit prescription drug (MA-PD) plans, and just about all plans present a number of further advantages like imaginative and prescient, listening to and dental advantages, just like final yr.

This temporary gives an outline of the Medicare Benefit plans which might be out there for 2025 and key traits over time. This evaluation makes use of information from the CMS Panorama recordsdata. On the whole, this temporary refers to particular person Medicare plans out there for common enrollment, excludes Particular Wants Plans (SNPs), besides the place famous, and excludes employer plans. (See methods for extra particulars.) A second, companion evaluation, describes premiums and advantages which might be out there for 2025 Medicare Benefit plans and over time.

Medicare Benefit Highlights for 2025

• The common Medicare beneficiary can have the choice of 34 Medicare Benefit prescription drug (MA-PD) plans in 2025, 2 fewer than the 36 choices out there in 2024. Throughout all plans for particular person enrollment, together with these with and with out prescription drug protection, the common beneficiary has 42 choices in 2025, in comparison with 43 choices in each 2023 and 2024.
• The variety of plans out there to the common beneficiary varies throughout states. In 28 states and Puerto Rico, the common beneficiary has a alternative of fewer plans in 2025 than in 2024, whereas in 16 states and DC, the common beneficiary has a alternative of extra plans, and in 5 states the variety of plans out there, on common, stayed the identical.
• Practically one-third of Medicare beneficiaries (32%) reside in a county with greater than 50 Medicare Benefit plans out there in 2025, up from 7 p.c in 2020, and just like 2024 (33%). Lower than 0.5 p.c reside in a county with no plans out there.
• The common Medicare beneficiary can select amongst plans supplied by 8 companies in 2025, the identical as in 2024. Three new insurers entered the Medicare Benefit market in 2025, whereas eight companies exited the market in 2025.
• Main insurers are each increasing into new counties and exiting others. For instance, Humana is coming into 12 new counties and exiting 70 counties, whereas UnitedHealthcare is coming into 42 new counties and exiting 38 counties. Each insurers are providing plans in almost 90% of all U.S. counties.
• About 5% of present Medicare Benefit enrollees in particular person MA-PDs (or about 1.4 million folks) are in a plan that has been terminated for 2025, whereas as much as 7% of enrollees in MA-PDs (or as many as 1.8 million folks) could also be affected by a consolidation, which means they’re in a plan the place some portion of the 2024 enrollment might be mechanically assigned to a unique plan in 2025.
• Greater than half (58%) of Medicare beneficiaries reside in a county (1,188) the place at the least one agency is providing 10 or extra plans for particular person enrollment.

Plan Choices in 2025

Variety of Plans

Variety of Plans Obtainable to Beneficiaries. For 2025, the common Medicare beneficiary can have entry to 34 Medicare Benefit prescription drug (MA-PD) plans, simply 2 fewer than the 36 in 2024 (Determine 1). Throughout all plans for particular person enrollment, together with these with and with out prescription drug protection, the common beneficiary has 42 choices in 2025, in comparison with 43 choices in each 2023 and 2024. Since 2018, the variety of plans out there to the common beneficiary has doubled. These numbers exclude employer- or union-sponsored group plans, Particular Wants Plans (SNPs), PACE plans, value plans, and Medicare-Medicaid plans (MMPs) which might be solely out there to pick out populations.

Complete Variety of Plans. In whole, 3,699 Medicare Benefit plans can be found nationwide for particular person enrollment in 2025 – a 7% lower from the variety of plans (260 fewer plans) supplied in 2024 (Appendix Determine 1).

HMOs account for greater than half (55%) of all Medicare Benefit plans supplied in 2025 however have declined as a share of all Medicare Benefit plans since 2017 (71% of plans), whereas throughout this era native PPOs rose as a share of all plans (Appendix Determine 1). Throughout this era, the share of plans which might be native PPOs elevated from 24% to 43%. The share of plans which might be regional PPOs has slowly declined from round 3% of plans supplied in 2017 to 1% in 2025.

Whereas many employers and unions additionally supply Medicare Benefit plans to their retirees, no Information about these 2025 plan choices is made out there by CMS to the general public through the Medicare open enrollment interval. Employer and union plans are administered individually and will have enrollment durations that don’t align with the Medicare open enrollment interval.

Particular Wants Plans (SNPs). In 2025, 1,442 SNPs might be supplied nationwide, an 8 p.c improve between 2024 and 2025 (Determine 2).

D-SNPs. Practically two-thirds of SNPs (63%) are designed for folks dually eligible for Medicare and Medicaid (D-SNPs). The variety of D-SNPs has elevated considerably since 2018, rising from 401 D-SNPs in 2018 to 906 D-SNPs in 2025 (up from 851 D-SNPs in 2024), suggesting insurers proceed to be drawn to this high-need inhabitants. In 2024, 5.9 million Medicare beneficiaries are enrolled in D-SNPs.

I-SNPs. The variety of SNPs for individuals who require an institutional-level of care (I-SNPs) almost doubled from 97 plans in 2018 to 189 plans in 2023, earlier than dropping modestly to 173 plans for 2024 and 160 in 2025. In 2024, about 115,000 Medicare beneficiaries are enrolled in I-SNPs.

C-SNPs. The variety of SNPs supplied for folks with persistent circumstances (C-SNPs) has almost tripled since 2018, from 132 plans that yr to 376 plans in 2025 (a rise of 67 plans since 2024). Most C-SNPs concentrate on folks with diabetes, coronary heart illness, or lung circumstances, as has been the case for the reason that inception of C-SNPs. For 2025, one agency is providing a C-SNP for folks with dementia (totally different than the one agency providing one in 2024). Two companies are providing C-SNPs for folks with psychological Health circumstances (in comparison with no companies in 2024), and one agency is providing a C-SNP for folks with HIV/AIDS, the identical one as in 2024. Ten companies are providing C-SNPs for folks with end-stage renal illness (up two from 2024). In 2024, 675,000 Medicare beneficiaries are enrolled in C-SNPs.

Variation in Medicare Benefit Plans, by State and County. The variety of plans out there to the common beneficiary varies throughout states (Determine 3; Appendix Desk 1). In 28 states and Puerto Rico, the common beneficiary has a alternative of fewer plans in 2025 than in 2024. In 16 states and DC, the common beneficiary has entry to extra plans in 2025 than in 2024. Within the remaining 5 states, the variety of plans out there to the common beneficiary stayed the identical. This consists of Alaska, which had no plans out there in 2025, as in 2024. Connecticut is just not included on this calculation – see methods for extra particulars.

Practically 2.2 million beneficiaries in 26 counties can select from 75 or extra Medicare Benefit plans in 2025 (down barely from 29 counties in 2024). In the identical 26 counties, beneficiaries can select from 63 to 73 Medicare Benefit plans with Half D protection. Just like the final three years, the counties with essentially the most plan choices are predominantly in Pennsylvania and Ohio. In Pennsylvania, for instance, beneficiaries can select from 80 or extra Medicare Benefit plans in 10 counties, together with Dauphin County (Harrisburg). Beneficiaries in Cumberland, Pennsylvania can select from 87 Medicare Benefit plans – essentially the most choices of any county within the U.S. In Ohio, beneficiaries can select from 80 or extra Medicare Benefit plans in 4 counties, together with Summit County (Akron) and Cuyahoga County (Cleveland). In Michigan, beneficiaries in Oakland County (Detroit metro space) can select from 75 plans (Determine 4).

In 2025, almost one-third (32%) of Medicare beneficiaries (in 9 p.c of counties) can select from greater than 50 Medicare Benefit plans (Determine 5).

Practically one-third of Medicare beneficiaries (32%) have a alternative of at the least 50 Medicare Benefit plans in 2025, roughly the identical as 2024 (33%). In 2025, lower than 0.5 p.c of beneficiaries reside in a county with one to 4 Medicare Benefit plans out there, whereas lower than 0.5 p.c of beneficiaries reside in a county with none plans out there. Just like 2024, there aren’t any Medicare Benefit plans for particular person enrollment being supplied in any county in Alaska in 2025, which incorporates about 99,000 beneficiaries. In 81 counties, about 250,000 Medicare beneficiaries (together with these in Alaska) is not going to have entry to a Medicare Benefit plan (a rise from 58 counties and about 196,000 Medicare beneficiaries in 2024). Moreover, no Medicare Benefit plans can be found in territories aside from Puerto Rico.

Variation in Medicare Benefit Plans by Geographic Standing. Medicare beneficiaries residing in metropolitan areas – counties with at the least 50,000 folks – can select from 45 Medicare Benefit plans in 2025 on common (down from 47 in 2024), together with 37 with Half D protection, considerably greater than beneficiaries residing in rural or micropolitan areas. Beneficiaries in micropolitan areas (10,000 to 50,000 folks) can select from a median of 31 plans (1 fewer plan than in 2024), together with 24 with Half D protection.

Beneficiaries in rural areas – counties with lower than 10,000 folks – can select from a median of 27 plans (the identical as in 2024), together with 20 with Half D protection. Since 2020, when 14 plans had been out there on common to beneficiaries residing in rural areas, the supply of plans in rural areas has almost doubled.

As in recent times, just about all Medicare beneficiaries (99.6%) have entry to a Medicare Benefit plan as a substitute for conventional Medicare, together with virtually all beneficiaries in metropolitan areas (99.9%), micropolitan (99.0%) and rural (97.8%) areas.

Medicare Benefit Plan Availability by Agency

The common Medicare beneficiary is in a position to select from plans supplied by 8 companies in 2025, the identical as in 2024 (Determine 6). Regardless of most beneficiaries accessing plans operated by a number of totally different companies, enrollment is concentrated in plans operated by UnitedHealthcare and Humana, and collectively UnitedHealthcare and Humana account for almost half (47%) of Medicare Benefit enrollment in 2024.

In 2025, almost one-third of beneficiaries (31%), in 169 counties, are ready to select from plans supplied by 10 or extra companies or different sponsors (a decline from 33% in 2024). In distinction, almost 5 p.c of beneficiaries reside in a county the place one to 3 companies supply Medicare Benefit plans (501 counties).

Additional, in 126 counties, just one agency will supply Medicare Benefit plans in 2025. These are principally rural counties with comparatively few Medicare beneficiaries (lower than 1 p.c of whole). In a few of these counties, there have been no companies providing Medicare Benefit in 2024, e.g., 5 counties in Idaho (Benewah, Clearwater, Custer, Lemhi, and Lewis). In distinction, Medicare beneficiaries in some counties had entry to plans supplied by two or three companies in 2024 however just one agency in 2025, akin to folks residing in Coos County, Oregon.

Availability of Plans by Agency and County. UnitedHealthcare and Humana, the 2 companies with essentially the most Medicare Benefit enrollees in 2024, have massive footprints throughout the nation, providing plans in most counties, just like 2024 (Determine 7).

Some main insurers are increasing into new counties, whereas leaving others (Determine 8).

Humana is providing plans in additional counties than some other massive Medicare Benefit insurer – 2,848 counties in 2025 – although that represents a lower of 58 counties from 2024. Humana is exiting 70 counties, whereas coming into 12 new counties. UnitedHealthcare is providing plans in 2,808 counties in 2025, a rise of 4 counties from 2024. UnitedHealthcare entered extra counties (42 new counties) than IT exited (38 counties).

Blue Cross Blue Defend Associates are providing plans in 2,604 counties in 2025, a rise of 35 counties from 2024. Blue Cross Blue Defend Associates are exiting 44 counties, however are coming into 79 new counties. CVS is providing plans in 2,227 counties, a rise of twenty-two counties. CVS exited 65 counties, however is coming into 87 new counties.

Insurer choices to exit some counties whereas coming into new ones might counsel that native market elements impression insurer evaluations about their potential to draw enrollees and earn a revenue.

A number of Plan Choices by Companies within the Identical County. Many Medicare Benefit companies are additionally providing a couple of plan possibility in every county.

Greater than half (58%) of Medicare beneficiaries reside in a county (1,188) the place at the least one agency is providing 10 or extra plans for particular person enrollment. For instance, in Cumberland County, Pennsylvania (the county with essentially the most plan choices – 87), 4 companies are providing 10 or extra plans (Humana, Blue Cross Blue Defend Associates, UPMC Health Plan, and CVS Health). In 125 counties, two companies are providing 10 or extra plans, and in 50 counties, three companies are providing 10 or extra plans.

In 2025, Humana is rising the variety of plan choices out there in 631 counties, whereas lowering the variety of plan choices in 1,192 counties. UnitedHealthcare is rising the variety of plans in 381 counties however lowering plan choices in 693 counties. Blue Cross Blue Defend Associates are rising the variety of plans choices in 698 counties, whereas lowering plan choices in 630 counties. CVS Health is rising the variety of plan choices in 667 counties, whereas lowering them in 775 counties. This additionally means that insurers consider native markets when making choices in regards to the variety of plans to supply and totally different county traits might make the market kind of enticing in a given yr to a specific insurer.

Plan Renewals and Terminations

In 2025, 5% of Medicare Benefit enrollees in MA-PDs or about 1.4 million folks, are in a plan that has been terminated for the approaching yr and won’t be mechanically assigned to a different plan. (This quantity consists of folks enrolled in SNPs however excludes folks in MA-only plans or folks with employer protection). Folks on this group will be capable of enroll in one other Medicare Benefit plan if one is out there or select conventional Medicare. In the event that they select conventional Medicare, they may qualify for a particular enrollment interval for Medigap with assured challenge rights, which means they will change to conventional Medicare and won’t be denied a Medigap coverage on account of a pre-existing situation.

One other 7% of Medicare Benefit enrollees in MA-PDs or about 1.8 million folks, are in plans which have been affected by a consolidation. On this state of affairs, some portion of this 1.8 million folks might be moved into one other plan below the identical insurer mechanically if the contract consists of one other plan of the identical kind (i.e., HMO or PPO) in the identical county. (Some enrollees in consolidated renewal plans is not going to see adjustments of their plan as a result of they had been already within the plan that different enrollees are actually being assigned to.) They might nonetheless enroll in one other Medicare Benefit plan if one is out there or select conventional Medicare. Nevertheless, they don’t qualify for a particular enrollment interval below federal regulation for Medigap.

New Market Entrants and Exits

In 2025, three companies (Wholesome Mississippi, SECUR Health Plan and UCLA Health Medicare Benefit plan) entered the marketplace for the primary time, whereas eight companies exited the market (Appendix Desk 2). Wholesome Mississippi has one new HMO plan out there for common enrollment in Mississippi, whereas UCLA Health is providing two HMO plans out there for common enrollment in California. SECUR Health Plan is providing two I-SNPs in Florida.

In the previous few years, some companies have launched plans which might be both co-branded or are in partnership with one other firm. For instance, in 2025, Alignment Health is providing three plans co-branded with Instacart in 7 counties in California and Nevada. These plans will supply groceries to qualifying beneficiaries with persistent circumstances. Alignment Health additionally companions with Walgreens and Ceremony Support. Different firms with a partnership which might be providing plans in 2025 embrace Choose Health and Kroger and Humana and USAA although this isn’t an exhaustive listing.

Eight companies that participated within the Medicare Benefit market in 2024 should not providing plans in 2025. Six of the companies had low enrollment in 2024 (round 10,000 or fewer enrollees per agency). Two of the companies had contracts taken over by different insurers.

Strategies

This evaluation focuses on the Medicare Benefit market in 2025 and traits over time. The evaluation of plan choices, availability of plans by state, county, agency, and insurer are based mostly on particular person Medicare Benefit plans for common enrollment. Along with the evaluation of SNP availability, SNPs are additionally included in counts of plan terminations and renewals in addition to entries and exits. Employer plans are excluded from this evaluation. Information on Medicare Benefit plan availability, enrollment, and premiums had been collected from a set of information recordsdata launched by the Facilities for Medicare & Medicaid Providers (CMS): Medicare Benefit plan panorama recordsdata, launched every fall previous to the annual enrollment interval Medicare Benefit contract/plan/state/county stage enrollment recordsdata, launched on a month-to-month foundation Medicare Benefit plan profit bundle recordsdata, launched quarterly Medicare Enrollment Dashboard recordsdata, launched on a month-to-month foundation Connecticut is excluded from the evaluation of Medicare Benefit on the county stage on account of a change in FIPS codes which might be within the Medicare Enrollment Dashboard information however should not but mirrored within the Medicare Benefit enrollment information. Some Alaskan counties are additionally excluded on account of variations in FIPS codes. In earlier years, KFF had calculated the share of Medicare beneficiaries enrolled in Medicare Benefit by together with Medicare beneficiaries with both Half A and/or B protection. We modified our strategy in 2022 to estimate the share enrolled amongst beneficiaries eligible for Medicare Benefit who’ve each Medicare Half A and Medicare B. These adjustments are mirrored in all information displayed trending again to 2010. Moreover, in earlier years, KFF had used the time period Medicare Benefit to seek advice from Medicare Benefit plans in addition to different sorts of personal plans, together with value plans, PACE plans, and HCPPs. Nevertheless, value plans, PACE plans, HCPPs are excluded from this evaluation along with MMPs. These exclusions are mirrored in all information displayed trending again to 2010. KFF’s plan counts could also be decrease than these reported by CMS and others as a result of KFF makes use of total plan counts and never plan segments. Segments typically allow a Medicare Benefit group to supply the “similar” native plan, however might fluctuate supplemental advantages, premium and value sharing in numerous service areas (typically non-overlapping counties).

Appendix