The Medicare Advantage program is looking like a gorilla in much of the country — but not everywhere.
In some counties, the program has a tough time competing with the traditional Medicare program for hospitals, physicians and enrollees.
The Medicare Part A program covers inpatient hospital services.
The Medicare Part B program covers physicians' bills and bills for outpatient services.
Congress created a third major Medicare program, Medicare Part C, to give private insurers a chance to use Medicare Part A and Part B subsidies to provide an alternative to traditional Medicare coverage.
The Medicare Advantage program, the biggest and best-known Medicare Part C program, now provides coverage for about 18 million of the 57 million Medicare enrollees.
The Centers for Medicare & Medicaid Services tracks Medicare Advantage plan enrollment data for about 3,300 counties. One of the columns in its Medicare Advantage enrollment spreadsheets shows the Medicare Advantage penetration rate, or the percentage of Medicare enrollees in a county who have Medicare Advantage plan coverage.
In the 50 U.S. states and the District of Columbia, the county penetration rates range from 0.4 percent, in Juneau, Alaska, to 71 percent, in Red Lake County, Minnesota.
The median penetration rate in the 50 U.S. states and the District of Columbia is about 24 percent.
Typical Medicare Advantage plan providers offer managed care plans. Some counties have low Medicare Advantage penetration rates because the number of hospitals and doctors is too low for use of a managed care network to make much sense.
When retirees are unhappy with Medicare Advantage plan provider directories, they typically combine traditional Medicare coverage with Medicare supplement insurance, or Medigap coverage. Retirees using Medigap coverage with traditional Medicare can use any provider that takes Medicare.
In more populous areas, the counties with low penetration rates tend to be the ones where providers have the financial strength to resist offers from health insurers' managed care networks, and many retirees have the cash to pay for a combination of traditional Medicare and Medigap coverage.
Those are, clearly, challenging markets for agents who sell Medicare Advantage plans, and rich markets for agents who sell Medigap plans.
To come up with a list of 10 counties in which the Medicare Advantage penetration rate looks awful, we first filtered the CMS penetration table data to exclude counties with fewer than 50,000 Medicare enrollees eligible to buy Medicare Advantage coverage. Those counties may have too few Medicare enrollees and providers to make Medicare Advantage plans sustainable.
In the 244 counties that remained after we filtered out the small-fry penetration rates ranged from 5 percent, in one county in California, up to 65 percent, in Dade County, Florida. The median penetration rate in those counties was about 36 percent.
Here's a look at the 10 counties with the lowest penetration rates, along with YouTube videos to give you a taste of what those counties are like.
The Lake County, Illinois Convention and Visitors Bureau posted a video of this county, which appears to be more fun for tourists than for Medicare Advantage plan marketers. (Video: visitlakecounty/YouTube)
10. Lake County, Illinois
Number of residents eligible for Medicare: 103,334
Number of Medicare Advantage plan users: 13,672
Medicare Advantage plans' share of Medicare enrollees: 13.2%
Robert Myrick of Robert Myrick Photography posted this video about Falmouth, a historic town in Barnstable County, Massachusetts, in July 2013. (Video: Robert Myrick A.K.A.-REMROB/YouTube)
9. Barnstable County, Massachusetts
Number of residents eligible for Medicare: 71,843
Number of Medicare Advantage plan users: 9,383
Medicare Advantage plans' share of Medicare enrollees: 13.1%
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New Castle County, Delaware, posted this video about a wellness fair and holiday craft sale in November. (Video: NCCDE/YouTube)
8. New Castle County, Delaware
Number of residents eligible for Medicare: 94,030
Number of Medicare Advantage plan users: 12,049
Medicare Advantage plans' share of Medicare enrollees: 12.8%
The University of New Hampshire Extension produced this video about life in Hillsborough County in December 2010. (Video: UNH Extension/YouTube)
7. Hillsborough County, New Hampshire
Number of residents eligible for Medicare: 73,903
Number of Medicare Advantage plan users: 9,436
Medicare Advantage plans' share of Medicare enrollees: 12.8%
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