Medicare Advantage enrollment in rural America has quadrupled since 2010, reaching 40% of eligible beneficiaries in 2023, but still far below the 53% penetration in metropolitan areas.
Rural beneficiaries now have an average of 27 MA plans to choose from, triple the options available in 2018, and 69% pay no premium beyond Part B, up from just 21% in 2015.
The rapid growth in rural plan choice and zero-premium options is creating new momentum for Medicare Advantage plans operating in rural markets, according to Tommy Ibrahim, MD, president and CEO of Sanford Health Plan.
Becker’s connected with Dr. Ibrahim to discuss why rural Medicare Advantage is a strategic focus, the benefits of an integrated delivery system, and how his team is positioning for long-term growth:
“If you look at Medicare Advantage beneficiaries who are eligible right now, the majority across the country are eligible for a comprehensive product and approach that ensures members receive all the care they need. We pride ourselves on being a 4.5-star plan. Compared head to head with traditional Medicare, the outcomes are significantly better.
The cost might be a little higher, and there’s evidence to support that, but it’s because of that bundled approach. Traditional Medicare recipients don’t have the same access. As more people opt for Medicare Advantage, they seek more services and use their benefits in a more holistic way. That drives costs up, but outcomes and quality of life improve significantly.
We feel strongly that MA will continue to be the preferred option for Medicare-eligible beneficiaries. Another reason we think it’s the right strategy is that MA penetration rates are significantly lower in rural America than in urban centers. In our geographic reach, Medicare penetration is between 20% and 30%, which leaves significant opportunity for growth, particularly as demographics shift toward age 65 and older. That’s where we see the growth coming from.
Uptake has been slow, but we believe that as we double down on the experience strategy, invest heavily in high-quality products, and work closely as an integrated healthcare delivery system to create a seamless member experience, the product will speak for itself. We expect traction and growth.
We’re always looking at our performance across the region and pruning over time. We’ve found that in geographies where we have both a health plan and a footprint of critical care delivery assets, we perform significantly better compared to relying on a broader, less integrated provider network. We’ve demonstrated that in terms of care quality through our HEDIS measures, member engagement and experience, and cost.
As we look at where we want to be geographically, we want to ensure that if we put something out there, we can back it up with high-quality care. That means geographic retrenchment in some areas, pricing redeterminations in others, and a holistic, strategic approach.”
