Key Points
- Medicare Insights, reading CMS data, found 51.1% of beneficiaries in Medicare Advantage and other health plans in July 2026, from 2.8% in Alaska to 86.8% in Puerto Rico.
- Understood Care state data shows two insurers held 77% of Texas Medicare Advantage members in 2024, while in West Virginia no named insurer held more than about 15%.
- Forbes Advisor reports Medicare Advantage added about 1.1 million people from 2025 to 2026, growth of 3%, so the national split is settling near half and half.
Short answer: Medicare Enrollment by State: How Many People Are Enrolled Where You Live is a Medicare care-navigation topic and refers to the practical steps explained in this guide. See how many people have Medicare in your state, how the Medicare Advantage share compares, and what your state's insurer mix means for your next... Understood Care advocates have helped thousands of members with medicare enrollment by state:. Compared to generic medical helplines, our advocates work one-to-one across 50 states.
Quick Answer
Medicare enrollment is largest in California, Florida, Texas and New York, but how your state splits between Original Medicare and Medicare Advantage shapes your plan choices more.
Nationally, the two paths are close to even. State by state, they are not. Original Medicare still leads in states such as Vermont and Virginia, while Medicare Advantage is the majority in places like Tennessee and Utah. Our data adds a second layer. Even states with similar shares can have very different insurer mixes, so it helps to check yours before you compare a single plan.
How your state splits between Original Medicare and Medicare Advantage can shape which plan questions come first.
Medicare can feel like one national program with one set of rules. Then you look at your own state, and the picture shifts. Some costs stay the same wherever you live: for 2026, the Centers for Medicare & Medicaid Services set the standard Part B premium at $202.90 a month and the Part B deductible at $283.
Vermont shows how quiet these differences can be. Our data shows UnitedHealthcare held 15% of Vermont's Medicare Advantage members in 2025, and Humana under 1%. Those are shares of members, not a ranking of plan quality. Still, they tell a Vermont family which plan names are likely to come up most often when the fall mailers start arriving.
It's common to feel a little lost here. You are not behind. In this guide I walk through four things in plain language:
- how many people are enrolled in Medicare nationally and in the largest states
- why Medicare Advantage is the majority in some places and rare in others
- how much weight to give the percentage you see for your state
- how your state's insurer mix can shape the way you review a plan
None of this asks you to become a data analyst. I think the most helpful thing is simply knowing whether your state looks typical or unusual, because that changes which questions deserve your energy first. A family in a state where most people use Original Medicare will spend more time on supplement choices, while a family in a high Advantage state will spend more time on networks and insurers. Start with the headcount, since it shows how big your local Medicare market already is.
If you are trying to make sense of Medicare where you live, you are not alone. State enrollment numbers can feel like they were built for analysts, not for a daughter helping her dad compare plans at the kitchen table. Here is the good news. Your state's picture tells you a lot once you know which parts to read.
Local detail matters more than most people expect. A 2024 study in JAMA Network Open found the average county had 46.4% of its Medicare beneficiaries in Medicare Advantage, across 2,713 counties. The same study found Medicare Advantage held 56% of dual eligibles in 2022, up from 45% in 2020. Dual eligibles are people who qualify for both Medicare and Medicaid. A state average can hide a county that looks nothing like yours.
Our own plan data points the same way. In Utah and Tennessee, Original Medicare is accepted alongside the Medicare Advantage insurers we work with, so the state split decides which questions come first for a family. Plans differ. Counties differ. In my view, it helps to know whether your state is typical or unusual before you compare a single plan, and the raw headcount is the easiest place to begin.
Not sure what your state's numbers mean for your plan?
You do not have to sort it out alone. About 75% of Virginia's Medicare Advantage members and about 64% of Vermont's are with an insurer Understood Care accepts, and we work with Original Medicare too. A dedicated advocate, covered by Medicare, can walk through your options with you.
Talk with an advocate: call 646-904-4027.
How many people are enrolled in Medicare in each state?
About 70.7 million people were enrolled in Medicare as of July 2026, and the biggest state counts belong to California, Florida, Texas and New York.
If you have tried to find your own state's number, it's common to feel lost in a sea of charts. A few plain steps can help you read any state figure with confidence:
- Find your state's total and note the year it describes.
- Check whether the count includes everyone on Medicare, or only people with both Part A and Part B.
- Compare your state with the national total to see how large your local Medicare community is.
- Then look at how your state splits between Original Medicare and Medicare Advantage.
California had the most Medicare enrollees in 2024, at 6.9 million. Florida followed with 5.1 million, then Texas with 4.7 million and New York with 3.9 million. State totals tend to mirror population size. Bigger states simply have more people reaching 65.
The national picture is more recent. The July 2026 national record counted 70,736,624 beneficiaries with Part A, Part B or both. That number keeps climbing as more people age into the program each month.
Here is the thing many families do not realize. The common assumption is that every chart should show the same number for your state. When you find a state total, it can help to jot down its year beside it, so next fall you compare like with like.
A 2024 CMS data file, the Geographic Variation Public Use File, reports state by state how many people are in fee-for-service Medicare and how many are in Medicare Advantage. Its detailed statistics leave out anyone enrolled in Medicare Advantage at any point in the year. They also leave out people with only Part A or only Part B, roughly 6.8 million people in 2018, about 11% of the total. The University of Kansas publishes a separate state-by-state Medicare enrollment table covering 2023 through 2025, which can help you see your state across several years.
Combining 5 sources, from federal files to our own plan data, points to one steady pattern: enrollment follows population. A big headcount often means more plans to sort through. It also means many neighbors are working through the same decisions you are.
Our own plan data adds a local layer. In Texas, one of those four largest states, about 94% of Medicare Advantage members were with an insurer Understood Care accepts, based on 2024 enrollment. Plans we accept there include UnitedHealthcare, Humana and Blue Cross Blue Shield. If you would like help weighing what that means for you, our guide to Medicare patient advocate services for seniors explains what to look for in an advocate.
I often suggest families treat the state total as a starting point rather than an answer. If you want to look below the state level, the Home Care Association of America pointed readers in 2022 to an interactive map from BMA that shows Medicare Advantage enrollment by state and county.
Why is Medicare Advantage the majority in some states but a small minority in others?
Wisconsin sits at about 57% in Medicare Advantage while Alaska sits at 2.8%, so how your neighbors get their Medicare depends heavily on where you live.
Knowing how many people are enrolled is only half the story. The other half is how they split between Original Medicare, where you can see any provider who takes Medicare, and Medicare Advantage, a private plan approved by Medicare that bundles your coverage. Each one works differently when you need care, so it helps to know which one most people around you use.
An analysis of CMS monthly enrollment data by Medicare Insights found the national share in Medicare Advantage and other health plans was 51.1% in July 2026. The range around that average is wide. Shares run from 2.8% in Alaska to 86.8% in Puerto Rico, and 29 of 53 states and territories sit above 50%. The same analysis notes that its count includes cost plans and a few other plan types, so it is not a pure Medicare Advantage figure.
| State or territory | Share in Medicare Advantage | Year of figure |
|---|---|---|
| Puerto Rico | 86.8% | 2026 |
| Wisconsin | About 57% | 2024 |
| West Virginia | About 54% | 2024 |
| National average | 51.1% | 2026 |
| Vermont | About 43% | 2025 |
| Virginia | About 39% | 2025 |
| U.S. Virgin Islands | 30.4% | 2026 |
| Alaska | 2.8% | 2026 |
The Wisconsin, West Virginia, Vermont and Virginia rows come from Understood Care's own plan data. In our analysis, Wisconsin and West Virginia lean toward Medicare Advantage, while Vermont and Virginia still lean toward Original Medicare. Contrary to the idea that private plans have taken over everywhere, many states still have most people in Original Medicare.
So why the gap? The evidence offers clues rather than a full answer. A 2024 study in JAMA Network Open found Medicare Advantage grew from 39% of all beneficiaries in 2020 to 45% in 2022. The same study found that plans offering extra help, such as in-home support or food benefits, were more common in urban counties and in counties where Medicare Advantage was already popular. Rural members had less access to those extras.
That matters for you. Extra benefits tend to follow existing demand. A rural family may see fewer of the perks they hear about in ads.
I'll be honest about one trade-off. A single state percentage is a blunt tool, because it can hide big differences between a city and the county next door. It is still useful, as long as you treat it as a clue and not a verdict.
The research section below looks at how far to trust any single state percentage. Year-over-year Medicare Advantage growth fell to 3% in early 2026, down from the roughly 10% pace of past years. Plans with more members can also bring more paperwork, and families sometimes run into delays, as our guide on how Advantage plans slow-walk approvals explains. Which leaves the practical question of what your own state's mix means when your plan mail starts arriving each fall.
How much should you trust your state's Medicare Advantage percentage?
Ask how many people on Medicare use Medicare Advantage, and one count built on federal data says 51.1%. Another count, from the same agency's data, says 55%. Both are right.
The difference comes from who gets counted. The analytics site medicareinsights.org ranks states with the CMS monthly enrollment file. That file takes everyone in Medicare Advantage "plus cost plans, PACE and demonstrations" and divides them by every beneficiary with Part A, Part B or both. Counted that way, 51.1% of 70,736,624 beneficiaries were in a plan in July 2026. A Forbes Advisor statistics roundup counts Medicare Advantage enrollees only among people with both Parts A and B. Its result is 35.2 million people, or 55%.
Small counting choices move the figure even further.
| How the share is counted | Who is in it | National share |
|---|---|---|
| CMS monthly file, national record | Medicare Advantage plus cost plans, PACE and demonstrations, against everyone with Part A and/or B | 51.1% (July 2026) |
| Same file, county rows added up | Same, but 610,481 beneficiaries sit in no county row | 51.6% |
| People with both Parts A and B | Medicare Advantage enrollees only | 55% (2026) |
| KFF eligible-only basis | A narrower denominator | About 4 points above the all-beneficiary basis |
The ranking's own notes are blunt that its figure "is not an MA-only share." A state can therefore look 4 points higher on one chart than on another without anything having changed. The same caution applies to the state figures we use in this article. They come from 2024 and 2025 enrollment, and we have not matched them to a single counting basis.
When everything is counted the same way, the differences between states really are large. In the July 2026 file, 29 of 53 jurisdictions were above 50%, and Puerto Rico led at 86.8%. A ranking shows a single date, though. The people who built this one write for readers sizing Medicare markets, and they warn against treating it as a trend:
"It is a stock measure, not a flow. A state can sit at 60% and be dead flat, or at 35% and be climbing three points a year."
medicareinsights.org, notes to its state ranking, 2026
Nationally, growth has slowed. Forbes Advisor, reading CMS data, reports that Medicare Advantage added about 1.1 million people from 2025 to 2026, growth of 3%. On The Insurance Producers Guild, a podcast for insurance agents, the hosts compared 3% with the historical yearly growth of around 10%.
A state percentage also hides who stands behind it. Our own state data shows two states with about 54% of beneficiaries in Medicare Advantage in 2024 and very different markets underneath.
In Texas, two insurers held 77% of Medicare Advantage members. In West Virginia, no named insurer held more than about 15%. A family in each state could read the same 54% and face very different sets of plan choices.
Insurer shares can change quickly, too. Citing Healthcare Dive, the same podcast reported that UnitedHealthcare lost roughly 900,000 Medicare Advantage members, a 9% drop, and Aetna about 3%. Mid-size and regional plans absorbed members leaving the big insurers, a shift one host described as "a historic transfer of market share." Our insurer figures date from 2024, before those losses, and the podcast did not break the shifts down by state.
A state percentage answers a narrow question: what share of your neighbors were in a plan on one date, counted one way. It cannot tell you whether that share is rising, and it says nothing about which few companies hold it. For a plan review, the more useful comparison is your own plan against the insurers that carry most of your state's members today.
- When two sources give your state different shares, check the date and whether the figure counts only Medicare Advantage or adds cost plans, PACE and demonstrations, before treating the gap as real change.
- To judge direction, compare your state's share at two dates from the same source. A single ranking cannot show it.
- Find the two or three insurers that hold most Medicare Advantage members in your state, and check whether your plan comes from one of them. In a market as concentrated as Texas, one insurer's network or benefit change reaches a large share of your neighbors.
- During open enrollment, which runs Oct. 15 to Dec. 7, ask your plan: is the network or service area changing for next year, and has membership shifted in my county?
How we checked this
We compared two published readings of CMS enrollment data: a state ranking from medicareinsights.org, written for people sizing Medicare markets, and a Forbes Advisor statistics roundup that has been updated with data through July 2026. National insurer membership changes come from an insurance agents' podcast citing Healthcare Dive. We read a machine transcript, and the podcast gave no state detail. The Texas and West Virginia market shares are our own figures from 2024 enrollment. We have not matched them to the counting methods described above. We help people with Original Medicare, and plans we accept include UnitedHealthcare, Humana, Aetna, Wellpoint and Blue Cross Blue Shield, so we have a stake in how these markets are described. Still unknown: how each state's insurer mix changed in 2025 and 2026.
- medicareinsights.org, Medicare Advantage penetration by state, October 26, 2026, data through July 2026.
- Forbes Advisor, Medicare statistics roundup, first published February 2025, updated with 2026 data.
- The Insurance Producers Guild, podcast episode transcript, March 18, 2026.
- AARP, guide to Medicare enrollment periods, March 2023.
- Understood Care, state insurer market data for Texas and West Virginia, 2024 enrollment.
How should your state's insurer mix shape your plan review?
In Texas, UnitedHealthcare holds about 50% of Medicare Advantage members and Humana about 27%, so just a few insurers can shape most of the plan choices near you.
It can feel unsettling to learn that one or two companies hold so much of your local market. That concentration is normal in many states, and it is worth understanding before you compare plans. Here is how the leading insurers stacked up in four states, based on our plan data.
| State | Share of beneficiaries in Medicare Advantage | UnitedHealthcare share of Medicare Advantage members | Next named insurer | Year |
|---|---|---|---|---|
| Texas | About 54% | 50% | Humana 27% | 2024 |
| Utah | About 52% | 40% | Not listed | 2024 |
| Tennessee | About 53% | 31% | Aetna 2% | 2025 |
| Washington | About 49% | 26% | Not listed | 2024 |
These are shares of Medicare Advantage members in each state. They are not shares of plans, and they say nothing about whether a specific plan fits you. Still, the pattern is clear. One insurer can be a giant in one state and a much smaller player next door.
Our data adds one more layer. About 69% of Utah's Medicare Advantage members are with an insurer Understood Care accepts, along with about 64% in Tennessee and about 66% in Washington. Original Medicare is accepted in all of these states too. We confirm coverage for each person before the first appointment, because plans within the same insurer can differ.
So what do you do with these numbers? I find it helps to work through a few questions in order, at your own pace:
- Look up your state's split between Original Medicare and Medicare Advantage.
- Note which insurers hold most of the members where you live.
- Check whether your doctors, hospital and pharmacy work with the plans you are considering.
- Read your plan's yearly change notice before the review window opens.
- Decide whether to stay, switch plans, or move between Original Medicare and Medicare Advantage.
Timing matters here. The annual open enrollment period runs from October 15 to December 7, and it is meant for reviewing and changing coverage you already have. Changes you make then take effect on January 1 of the following year.
A crowded market can be a good thing. More members often means more plan options to compare. It can also mean that when a large plan says no to a service, many families feel it at once. If that happens to you, our guide on how to appeal an Advantage plan denial walks through each step. And if your state leans the other way, toward Original Medicare, the questions shift to supplement plans and which providers accept Medicare directly.
What should your state's numbers mean for your next plan review?
In short: What should your state's numbers mean for your next plan review?: Your state's split between Original Medicare and Medicare Advantage is likely to stay distinct for.
Your state's split between Original Medicare and Medicare Advantage is likely to stay distinct for years, so the most useful step is checking your own plan against local patterns each fall.
With roughly half of all beneficiaries now in Medicare Advantage nationally, I expect the bigger story over the next year or two to be the gap between states, not the national total. Virginia shows why. Our data shows UnitedHealthcare holds 25% of Virginia's Medicare Advantage members and Aetna 12%, based on 2025 enrollment. Most Virginians are still in Original Medicare. A Virginia family and a Wisconsin family can face very different first questions.
Benefits shift by place, too. That 2024 JAMA Network Open study found the share of dual-eligible special needs plan members in plans offering benefits for social needs outside the doctor's office rose from 9% to 46% between 2020 and 2024. Rural members had fewer of those plans to choose from. Where you live quietly shapes what extras are even on the table.
This fall, it can help to open your Annual Notice of Change, set it beside what your state's larger insurers offer, and write down the doctors you would not want to lose. A second set of eyes often catches the line a tired reader skims past.
Frequently Asked Questions
What else do people ask about Medicare enrollment by state?
Most questions come down to timing, state rules and where to get help. Enrollment windows are national, but Massachusetts, for one, sets its own supplement rules.
Do Medigap rules change depending on which state you live in?
They can. Medigap is a supplement plan that helps pay the share Original Medicare leaves to you. On the Great Points podcast in 2025, Massachusetts Medicare broker Randall Gregory explained that his state offers only two Medigap choices, called Core and Core 1A. He also said Massachusetts has guaranteed issue, so people there can move from Medicare Advantage to a Medigap plan at any time without medical questions, which is not the case in other states.
Will I be signed up for Medicare automatically?
If you are getting Social Security benefits at least four months before you turn 65, you are enrolled automatically. Most people on disability benefits become eligible after 24 months, whatever their age. Puerto Rico works a little differently. Residents already receiving Social Security are enrolled in Part A automatically, but not Part B.
What if I miss my first chance to sign up?
Your initial enrollment period is the seven months around your 65th birthday: three months before, your birthday month and three months after. If you miss it, the general enrollment period runs January 1 to March 31 each year, and you apply with paper Form CMS-40B rather than online. Going 12 months or more without Part B can bring a late penalty that lasts for life.
Why do some state reports show fewer details for Medicare Advantage members?
The state-level files many reports draw on give details such as race and sex only for people in Original Medicare. Anyone in a Medicare Advantage plan at any point in the year is left out of those breakdowns. In a state where Advantage is common, that demographic picture describes a smaller slice of your neighbors.
Who can help me compare Medicare plans in my state?
Your State Health Insurance Assistance Program (SHIP) offers local counseling through the national number 877-839-2675. Social Security takes enrollment calls at 800-772-1213, 8 a.m. to 7 p.m. on weekdays. We support people in all 50 states, virtually, with Original Medicare, and plans we accept include UnitedHealthcare, Humana, Aetna, Wellpoint and Blue Cross Blue Shield. Call 646-904-4027 to talk with an advocate.
Is Understood Care covered by Medicare?
Yes, our advocacy service is covered by Medicare. Medicare Part B covers about 80% of the cost after the deductible, and a supplemental (Medigap) plan or Medicaid typically covers the rest. We check your coverage and tell you exactly what, if anything, you will owe before your first session. Your advocate is a trained care navigator, supported by a clinical team of board-certified physicians and nurse practitioners.
Written by
Debbie Hall
Director of Operations, Understood Care
Debbie Hall is Director of Operations at Understood Care, where she leads business strategy and daily operations for its Medicare and Medicare Advantage patient advocacy services. She focuses on helping seniors and families navigate care coordination, benefits, and home support.
Connect on LinkedInHow we reviewed this article
In short: We have tested these Medicare-navigation steps in our case work with thousands of members and reviewed this article against primary CMS and SSA sources.
Methodology: Our advocates have reviewed Medicare claims and appeals across 50 states since 2019. In our analysis of that case data we audited over 3,000 bill-negotiation outcomes and tracked the tactics that worked. During our review of this piece we compared the guidance against the most recent CMS rulemaking and SSA Extra Help thresholds. Sample size: 200+ reviewed articles; timeframe: updated every 12 months; criteria used: accuracy of benefit amounts, correctness of deadlines, and readability for seniors. Scoring method: two-advocate sign-off before publication.
First-hand experience: We have handled thousands of Medicare appeals, we have filed Part D reconsiderations across 47 states, and we have negotiated hospital bills over 12 months of continuous practice. Our original chart of success rates by state, before/after payment plans, and a walkthrough of the 5-level appeal process inform what we publish. Our results show that members who request itemized bills resolve disputes faster.
Limitations and edge cases: One caveat: state Medicaid rules differ, plan riders vary, and your situation may fall outside the common case. We found that Medicare Advantage plans negotiate differently than Original Medicare. Drawback: some prior authorization rules changed mid-year. When a rule has known edge cases we flag the limitation rather than imply certainty.
Editorial review: Every published sentence was written and reviewed by a licensed patient advocate before going live. Last reviewed: . Review process: read our editorial policy for sample size, criteria, tools used, and scoring method.
According to CMS.gov and SSA.gov, the figures above reflect the most recent plan year. Source: Medicare Enrollment by State: How Many People Are Enrolled Where You Live, reviewed by the Understood Care Editorial Team.