Top 5 Medicare Advantage payers by footprint in 2025

Humana

Overall, Humana offered plans in 2,848 counties in 2025, according to KFF. This represents a decrease from the number of plans offered in 2024. The payer entered 12 new counties in 2025 and left 70, resulting in a difference of 58 counties from 2024 to 2025. Nevertheless, even when losing ground, the payer maintained its dominant footprint, beating out the runner-up, UnitedHealthcare, by 40 counties.

The major payer took steps to lower costs and improve access for members in its 2025 plan offerings, according to its open enrollment press release. For example, Humana extended access to its popular Humana Full Access PPO plan. The plan allows members to see in- and out-of-network providers at the same cost. It also eliminates the need for a referral.

In the payer's LPPO MAPD Giveback plans and USAA Honor Giveback plans, members can receive a "giveback benefit" that enables them to lower their Medicare Part B premium, according to Humana's press release. The USAA Honor Giveback plan is designed to serve veterans by coordinating traditional benefits with Veterans Affairs benefits and offering a customer service line strictly for veterans. The LPPO MAPD Giveback plans also nixes referrals and allows members to go to any Medicare-accepting provider.

Humana sought to tailor plans for members with complex healthcare needs. Its Institutional Special Needs Plan (I-SNP) includes a music therapy session benefit for 2025, allowing members to address their mental health conditions with a certified music therapist. The payer's dual-eligible special needs plans (D-SNPs) offer members an allowance that rolls over month-to-month and can be put toward groceries, rent and utility bills, among other costs. The Chronic Condition Special Needs Plans (C-SNPs) offer traditional benefits and give members access to a care manager.

Humana's prescription drug coverage underwent some changes for the 2025 plan year. For example, the payer established zero-dollar co-pays for tier 1 and tier 2 drugs for three-month supplies from mail-order pharmacies in the Humana Premier Rx plan. Both the Value Rx and Premier Rx plans eliminate coverage gaps and establish an out-of-pocket maximum.

The payer is familiar with being among the highest-performing Medicare Advantage payers. Humana reported strong growth in Medicare Advantage enrollment in the payer's 2024 first-quarter earnings call. At the time, the company's leaders projected that they would add 150,000 members to Medicare Advantage individual plans and another 45,000 to group plans over the course of the year.

UnitedHealthcare

This major payer increased its presence in 2025, adding four more counties to its total from 2024 to 2025, KFF found. In the coming year, UnitedHealthcare will be able to boast of having plans in 2,808 counties across the U.S. The payer abandoned 38 counties and entered 42 new ones. UnitedHealthcare also boosted the number of plans it had in 381 counties. However, it diminished the number of offerings in 693 counties.

The payer launched 140 new plans in 2025, according to a press release about the changes UnitedHealthcare made to its Medicare Advantage plans for 2025 open enrollment. It expanded its D-SNPs and doubled its C-SNP footprint. The payer stated that most eligible beneficiaries have a UnitedHealthcare D-SNPs available to them (93%).

With this extensive reach, UnitedHealthcare is in a better position to tackle access to care in the Medicare Advantage population. Given the payer's footprint, more Medicare Advantage beneficiaries will have access to UnitedHealthcare's provider network of 1 million in-network providers. The payer stated that this is the largest Medicare Advantage network in the country.

In an effort to attract members with lower costs, UnitedHealthcare's standard plans might include benefits like zero-dollar co-pays on important services from lab tests to virtual care visits. One new standard plan offers some members a quarterly allowance that members can use to reduce some out-of-pocket healthcare spending.

Since seniors often face one or more chronic diseases and juggle multiple medications, lowering prescription drug costs for Medicare beneficiaries is a key priority for payers. UnitedHealthcare's Medicare Advantage plan aims to accomplish this by covering common, lower-cost drugs and by placing 20 widely-used drugs in the lowest-cost tiers on their formulary (tier 1 and tier 2). Additionally, tier 1 and tier 2 drugs have no co-pay through UnitedHealthcare's delivery pharmacy.

In 2025, UnitedHealthcare is transitioning its healthcare payment card, UCard, from a barcode to a magstripe to improve the user experience. With this card, members can pay for care and receive credits for over-the-counter goods and food, depending on the plan.

Although Humana retained its status as the payer with the largest footprint in the U.S., UnitedHealthcare has, historically, vied for higher Medicare Advantage enrollment and had the upper hand among payers in the Medicare Advantage market share. UnitedHealthcare has had the largest market share in 42% of metropolitan statistical areas, American Medical Association found. In this aspect, the payer definitively exceeded its runner-up, Humana, which held 22% of the market share in these areas.

Additionally, including all lines of business, UnitedHealthcare is the largest payer in the U.S.

The Blues

Blue Cross Blue Shield Association (BCBSA) affiliates trailed close behind UnitedHealthcare with plans in 2,639 counties in 2025, KFF noted. Additionally, the payer entered more new counties than Humana and UnitedHealthcare combined. BCBSA left 44 counties and entered 79 counties, resulting in a gain of 35 counties from 2024 to 2025.

Due to the organizational structure of BCBSA with its many independent companies, BCBSA plan offerings might vary. In this article, we will highlight three from different geographical segments of the U.S.

Blue Shield of California

The new features that Blue Shield of California (Blue Shield) highlighted impacted its pharmacy, EHR and wellness coverage.

With its Amazon Pharmacy benefit, the payer committed to offering home deliveries from Amazon Pharmacy with no extra costs. The payer's new Member Health Record allows 2025 members to digitally access their own health information and history more easily. Lastly, the Blue Zones Challenge app takes the data and lessons learned from regions with strong population health outcomes and offers it to members in areas with poorer health outcomes.

"Seniors face real challenges, from managing complex medication schedules to accessing the right care when they need it. By leveraging innovative technology and personalizing care, we're simplifying health care and making it easier for our members to navigate their health needs," Alex Uhm, vice president and general manager of Medicare at Blue Shield of California, said in Blue Shield's press release.

Florida Blue

Florida Blue emphasized that policy-related factors and changes might influence 2025 Medicare Advantage offerings.

"These changes will likely affect the benefits, premiums and provider networks of Medicare Advantage plans across the industry," Lee Bowers, president of Florida Blue Medicare, explained in the press release. "That's why this year, especially, it's essential that individuals carefully review their health care options during AEP and make informed decisions to ensure they have the coverage that meets their needs."

Despite the impending shifts, the payer's plans continue to offer traditional benefits and supplemental benefits. For example, the payer offers up to $125 to members in HealthyBlue rewards. Members can also access transportation to appointments at no extra cost, care management from registered nurses, discounts on wellness expenses and tools for caregivers.

Independence Blue Cross

Independence Blue Cross (IBX) launched two new Medicare Advantage plans in 2025.

The payer highlighted a couple of key benefits in the Keystone 65 Essential Rx HMO-POS including its $3,000 yearly allowance for dental services. The plan also includes grocery and transportation benefits. Meanwhile, the Personal Choice 65 Plus PPO is designed with zero-dollar co-pays for primary care and specialist visits, if they are in-network. The plan likewise offers dental benefits with a $1,500 yearly dental allowance.

"As the Medicare landscape continues to grow and change, we remain steadfast in our commitment to serve seniors who are looking for health care coverage they can trust," Kortney Cruz, senior vice president of government markets at IBX, shared in the press release.

CVS Health

Following the Blues, CVS Health had the fourth highest county-level penetration, with a presence in 2,249 counties, the KFF brief identified. The payer increased the number of counties it offered plans in from 2024 to 2025 by 22 counties. It entered 87 counties in 2025 and exited 65.

Aetna, CVS Health's insurance arm, set out to address quality, affordability and accessibility, the payer mentioned in its press release for open enrollment.

One of the steps Aetna took to this end was to reduce cost-sharing. Specifically, the payer boasted a zero-dollar monthly premium and a zero-dollar co-pay on tier 1 prescription drugs and primary care services. According to the payer, a little over eight in ten Medicare-eligible beneficiaries can access a zero-dollar premium Aetna plan (83%).

The payer also evolved its approach to chronic disease and dual-eligible populations. It launched C-SNPs in Chicago, Philadelphia and Pittsburg to expand access to care for members with chronic diseases. The plans have zero-dollar co-pays for visits to primary care providers and certain chronic disease specialists. And to lower drug costs for dual-eligible special needs plan members, these individuals can access zero-dollar deductibles and Part D prescription drug co-pays, but only at in-network pharmacies.

To serve Part D members who might make the switch from Medicare Part D standalone plans to Medicare Advantage plans, Aetna launched the Medicare SmartFit plans. These plans are only accessible in 10 states and they offer traditional benefits with a zero-dollar premium and zero-dollar co-pay for certain in-network services and tier 1 and 2 drugs.

To lower prescription drug costs for more members, the payer introduced reduced or, depending on income status, zero-dollar co-pays for medications related to certain chronic diseases. As a core benefit, Aetna's Medicare Advantage members have zero-dollar co-pays for tier 1 drugs and most Medicare Part D-covered vaccines. Some plans have zero-dollar deductibles on drug tiers 1 through 5.

Aetna sought to address members' desire for quality of care by encouraging them to access high-value providers. On some plans, members can get bonus dollars on their Aetna Medicare Extra Benefits card or lower cost-sharing for going to a high-quality primary care provider.

"For 2025, our continued focus is ensuring members have the peace of mind that comes with access to reliable, affordable health care when and where they need it," Anand Shukla, president of Aetna Medicare, shared in the press release.

Earlier in 2024, CVS Health acquired a Medicare Advantage broker after its Q1 report exhibited disappointing performance in the Medicare Advantage sector.

Centene

Centene is offering plans in 1,772 counties nationwide, according to KFF. The payer had the highest number of counties entered as well as the highest number of counties exited of any of the top five payers in this space. Centene entered 134 counties and exited 110, resulting in a gain of 24 counties between 2024 and 2025.

Like its competitors, Centene highlighted several steps it was taking to address members' cost, quality and accessibility concerns in its open enrollment press release.

To tackle access to care, Wellcare (Centene's Medicare brand) poured $22 million into its Find a Provider tool. The platform opens up a spectrum of tools for both current and potential members.

For better access to mental and behavioral healthcare specifically, in 2025 members have access to the Twill by Dario platform through their Wellcare Medicare Advantage-Prescription Drug plan. With this tool, members are able to get support any time of the day, night or week through both self-guided and peer support options.

The Wellcare Spendables card seeks to lower out-of-pocket healthcare spending for members. In 2025, some plans allow members to use this card for safety and home improvement products. Other potential uses include over-the-counter products, gasoline and rent assistance. In another effort to lower costs, the plan also has a zero-dollar co-pay for tier 1, 2 and 6 drugs at preferred pharmacies like CVS and Walgreens.

"Wellcare remains focused on meeting the needs of the most vulnerable beneficiaries in our footprint through our strong dual-eligible products, and we continue to invest in services across the organization to provide high-quality care and the best experience possible," Michael Carson, CEO of Wellcare, stated in the press release.

Earlier in 2024, Wellcare also announced a multiyear partnership with Pearl Health, seeking to improve Medicare Advantage members' access to value-based care. The partnership will leverage Pearl Health's technological tools to empower primary care providers in value-based arrangements.

So, during this open enrollment season, do members have access to more affordable coverage, higher quality of care, better access to care and other benefits that they prioritize? The five firms with the most significant county-level presence are certainly making a bid to potential enrollees with discounts, care management and lower out-of-network costs.

However, the results of these efforts will only become clear in member feedback through channels like the patient experience section of the 2025 Medicare Advantage Star Ratings and industry surveys like the JD Power member satisfaction survey.

Kelsey Waddill is a managing editor of Healthcare Payers and multimedia manager at Xtelligent Healthcare. She has covered health insurance news since 2019.