Plan-choice overload
Is the flood of plans reaching everyone, or is it concentrated where most beneficiaries actually live?
The average Medicare beneficiary could pick among 43 Medicare Advantage plans in 2024, more than double 2018, yet in the closely related Part D market only 5.2 percent chose the cheapest plan that covered their drugs.
The problem
Plan choice overload is a market-design failure in which nominal competition can overwhelm beneficiaries without creating meaningful differentiation. Hospitals and clinicians then absorb churn, network confusion, billing friction, and care disruption when patients select plans they do not fully understand.
The recommendation
Simplify choice architecture where plan abundance is not functioning as real competition. The recommended response is to reduce look-alike offerings, improve default and comparison tools, and focus oversight in counties where many beneficiaries face many nominal options from relatively few firms.
The scale, and who's exposed
How far plan choice has proliferated and how unevenly it lands: the national trend, the county-versus-beneficiary concentration split, and the geography of who gets 80 plans versus one.
Medicare Advantage plans available to the average beneficiary
Bound to plans per beneficiary, KFF's headline series. A simple per-county mean was only retrievable for 2024 (29.1 plans), lower than the beneficiary-weighted figure because plan-dense metros carry more enrollees.
Read it this way The line dips before it climbs: plans per beneficiary fell from 30 in 2010 to a low of 17 in 2014 and 2015, then rose every year to a peak of 43 in 2024 before easing to 39 by 2026. The recent easing means the 2024 peak was not necessarily the end point, though the chart does not explain why the count fell in the early 2010s or rose afterward. Use this chart to distinguish real competition from nominal plan volume, then connect the finding to the recommendation to simplify choices where abundance becomes navigation burden.
⊞ data table⬇ CSV
| Year | Avg plans per beneficiary |
|---|---|
| 2010 | 30 |
| 2011 | 18 |
| 2012 | 19 |
| 2013 | 19 |
| 2014 | 17 |
| 2015 | 17 |
| 2016 | 18 |
| 2017 | 18 |
| 2018 | 20 |
| 2019 | 24 |
| 2020 | 28 |
| 2021 | 33 |
| 2022 | 38 |
| 2023 | 42 |
| 2024 | 43 |
| 2025 | 42 |
| 2026 | 39 |
KFF, Medicare Advantage Spotlight series (Figure 1 chart data) · 2010-2026 · source
Where the plans are versus where the people are, 2024
Each plan-count bucket, showing what share of counties versus what share of beneficiaries it holds. Low-plan buckets are many counties but almost no people. High-plan buckets are few counties holding most beneficiaries.
Read it this way Compare the teal and coral bars in each bucket: low-plan buckets like 0 and 1-10 hold a large share of counties but almost no beneficiaries, while high-plan buckets like 41-50 and 61+ hold few counties but a large share of beneficiaries. This mismatch shows plan overload concentrates on people, not places, since most beneficiaries live in the small number of counties with the most plans. Use this chart to distinguish real competition from nominal plan volume, then connect the finding to the recommendation to simplify choices where abundance becomes navigation burden.
⊞ data table⬇ CSV
| Plans available | Share of counties % | Share of beneficiaries % |
|---|---|---|
| 0 | 2.1 | 0.29 |
| 1-10 | 10.6 | 2.38 |
| 11-20 | 15.7 | 6.32 |
| 21-30 | 24.3 | 14.26 |
| 31-40 | 27.7 | 23.19 |
| 41-50 | 11.4 | 20.71 |
| 51-60 | 4.2 | 14.09 |
| 61+ | 3.9 | 18.76 |
KFF, Medicare Advantage 2024 county-level plan-count file · 2024 · source
Average Medicare Advantage plans by area type, 2024
Average plans by area type in 2024. The reference line is the 43-plan national average, which sits near the metro figure because that is where most beneficiaries live.
Read it this way The three bars compare average plan counts by area type against the 43-plan national reference line: metropolitan areas exceed it at 47, while micropolitan (32) and rural (27) areas fall well below. The chart shows metro beneficiaries drive the national average up; it does not show whether rural beneficiaries have plans that meet their needs. Use this chart to distinguish real competition from nominal plan volume, then connect the finding to the recommendation to simplify choices where abundance becomes navigation burden.
⊞ data table⬇ CSV
| Area type | Average plans |
|---|---|
| Metropolitan | 47 |
| Micropolitan (10,000-50,000 people) | 32 |
| Rural (fewer than 10,000 people) | 27 |
KFF, Medicare Advantage 2024 Spotlight: First Look · 2024 · source
Is more choice better?
Whether the flood produces better decisions or just noise: how rarely people pick the optimal plan, what it costs them, and how few insurers actually stand behind the 43 options.
Nominal choice versus real competition per beneficiary, 2024
Nominal choice versus real competition for the average beneficiary in 2024. Most of the 43 plans are variants from the same 8 insurers, and the firm count fell from 9 in 2023 even as plans rose.
Read it this way The two bars contrast nominal and real choice: 43 plans are available but only 8 firms actually offer them, down from 9 the year before. The gap means much of the 43-plan count is variants from the same handful of insurers, not 43 independent options. Use this chart to distinguish real competition from nominal plan volume, then connect the finding to the recommendation to simplify choices where abundance becomes navigation burden.
Caveat The plan count of 43 is a structured KFF field. The firm count of 8, down from 9 in 2023, is parsed from KFF's written First Look brief.
⊞ data table⬇ CSV
| Measure | Count |
|---|---|
| Plans available | 43 |
| Firms available | 8 |
KFF, Medicare Advantage 2024 Spotlight: First Look · 2024 · source
Why this matters
The 43-plan figure overstates real competition: only 8 firms actually offer those plans in 2024, down from 9 in 2023, meaning much of the growth is look-alike products from a shrinking set of insurers rather than genuinely independent options. Whether more options help is directly testable in the closely related Part D drug-plan market, where only 5.2 percent of beneficiaries chose the cheapest plan that covered their medications, and the average non-optimal choice cost $368 a year, with more than one in five beneficiaries able to save over $500 by switching. A market that already fails to help people choose well among fewer options is unlikely to do better as the count climbs.
Recommended actions
- Restore or strengthen a meaningful-difference standard between plans from the same insurer, since 43 plans from 8 firms suggests substantial duplication.
- Prioritize plan-comparison tools and default recommendations in the counties with 50 or more plans, where the 32.9 percent of beneficiaries facing the worst overload are concentrated.
- Address the 130 single-insurer counties as a separate access problem, not a choice-overload problem, since it requires competition policy rather than plan-count limits.
- Fund a direct Medicare Advantage version of the Part D overspending study, since the current cost-of-confusion estimate is an analogue, not a direct measurement.
The recommendation
Therefore, simplify choice architecture where plan abundance is not functioning as real competition. The recommended response is to reduce look-alike offerings, improve default and comparison tools, and focus oversight in counties where many beneficiaries face many nominal options from relatively few firms.
Demographic slice none. CMS plan-landscape files are county or plan-level.
Sources
- KFF, Medicare Advantage 2024 Spotlight: First Look · 2024
- KFF, Medicare Advantage 2024 county-level plan-count file · 2024
- Health Affairs, The Vast Majority of Medicare Part D Beneficiaries Still Don't Choose the Cheapest Plans (Zhou and Zhang) · 2012
- Medicare Rights Center, Medicare Advantage Proliferation · 2025