Regional Medicare Spending Growth Per Beneficiary: 2019 – 2020

There is substantial geographic variation in the rate of growth in Medicare spending per beneficiary due to geographic differences in the severity of the COVID epidemic and state and local policies affecting business activity. The decline in health care utilization will affect future ACO benchmarks and annual update factors. We calculated the annual change in spending per ACO assignable Medicare beneficiary in 998 cities. Per-capital spending is annualized, truncated and adjusted to remove COVID-19 spending according to MSSP program rules.

Click on a state to see the Medicare 2019-2020 per capita spending trend by city.

Notes: Please see our methodology for calculating per beneficiary spending trends.


  • Annual trend rates calculated using 2019 and 2020 Q1 – Q4 quarterly claims data from the Medicare Research Identifiable Files.
  • Spending and beneficiary months for MSSP assignable beneficiaries with at least one E&M visit were calculated at the county level for each Medicare eligibility category (Aged-Non-Dual, Aged-Dual, Disabled, ESRD).
  • We calculated spending for COVID-19 episodes as defined in the December 2020 MSSP Specifications of Policies to Address the Public Health Emergency for COVID-19.
  • Spending data for each beneficiary category and year were annualized and truncated based on the approach specified in MSSP Shared Savings and Losses and Assignment Methodology Version #9. We repeated this step for 2020 spending minus COVID-19 expense.
  • County level spending and beneficiary years were aggregated into core-based statistical areas (CBSAs). We calculated spending per beneficiary year for each eligibility category for each CBSA in 2019 and 2020.
  • We calculated change in spending per Medicare beneficiary between 2019 and 2020 by eligibility category with and without COVID-19 expenses.
  • We calculated change in total spending per Medicare beneficiary between 2019 and 2020 holding the percentage of beneficiaries in each eligibility constant within each CBSA.