cms-provider-data-catalog · CMS
cms-provider-data-catalog · CMS
cms-provider-data-catalog · CMS
cms-provider-data-catalog · CMS
cms-provider-data-catalog · CMS
CMS publishes two maps from one file. The Market Saturation & Utilization State-County data counts, for each county, state, and the nation, how many providers bill Medicare fee-for-service in a service category — the saturation half, the supply of care — but it also counts how many beneficiaries actually use the service. That second number is the utilization half, the demand side, and it answers a different question: not how many providers are out there, but how much of Medicare's population a service actually reaches. Read the utilization map and the program looks far more concentrated than the provider counts suggest.
Only one Medicare service reaches more than half its people
Divide the users of a service by the fee-for-service population and you get its penetration — the share of beneficiaries it reaches. In 2025 exactly one of the 24 categories cleared half: preventive health services, at 53.6%, reaching 21.2 million of Medicare's 39.6 million fee-for-service beneficiaries. Everything else trails, and most trail badly: the median service reaches under 6% of beneficiaries, and seventeen of the twenty-four reach under 10%.
| Service | Providers | Beneficiaries reached | Share of FFS |
|---|---|---|---|
| Preventive health services | 225,876 | 21,248,672 | 53.6% |
| Diagnostic testing facility (Pt A) | 3,883 | 16,742,549 | 42.3% |
| Clinical laboratory | 2,303 | 15,554,744 | 39.3% |
| Ophthalmology | 47,498 | 12,283,238 | 31.0% |
| Pulmonology | 180,428 | 9,326,391 | 23.6% |
| Durable medical equipment | 45,963 | 7,358,733 | 18.6% |
| Podiatry services | 15,172 | 4,425,256 | 11.2% |
| Physical & occupational therapy | 95,124 | 3,839,619 | 9.7% |
| Home health | 8,488 | 2,613,941 | 6.6% |
| Psychotherapy | 35,557 | 2,108,821 | 5.3% |
| Skilled nursing facility | 12,919 | 1,141,379 | 2.9% |
| Hospice | 5,024 | 915,164 | 2.3% |
| Dialysis | 6,409 | 235,402 | 0.6% |
Source: CMS Market Saturation & Utilization, NATION + TERRITORIES aggregation, 2025 reference period; thirteen of the twenty-four categories shown, spanning the range.
Utilization is what beneficiaries actually use — not what is billed, and not how good the care is. A high share means a service reaches many people; a low one can mean it is specialized, discretionary, or simply hard to get. The map shows reach, never merit.
The top of the list is not where most of the dollars are. Preventive health, diagnostic testing, and clinical labs reach the most people because nearly every beneficiary touches them in the course of ordinary care — an annual wellness visit, a blood panel, an imaging order. The high-cost categories that dominate Medicare spending — skilled nursing, hospice, dialysis — sit near the bottom, because they reach a small, sick slice of the population intensively. Penetration and spending are different axes.
The few facilities that carry the load
The penetration table hides a second pattern, visible only when you set the number of users a service reaches against the number of providers delivering it. That ratio — CMS reports it directly as average users per provider — is the caseload each provider carries, and across Medicare it spans a factor of 184.
| Service | Providers | Beneficiaries reached | Users per provider |
|---|---|---|---|
| Clinical laboratory | 2,303 | 15,554,744 | 6,754 |
| Diagnostic testing facility (Pt A) | 3,883 | 16,742,549 | 4,312 |
| Ambulance (emergency & non-emergency) | 8,504 | 3,752,418 | 441 |
| Home health | 8,488 | 2,613,941 | 308 |
| Ophthalmology | 47,498 | 12,283,238 | 259 |
| Hospice | 5,024 | 915,164 | 182 |
| Durable medical equipment | 45,963 | 7,358,733 | 160 |
| Psychotherapy | 35,557 | 2,108,821 | 59 |
| Pulmonology | 180,428 | 9,326,391 | 52 |
| Chiropractic services | 25,597 | 1,329,758 | 52 |
| Physical & occupational therapy | 95,124 | 3,839,619 | 40 |
| Dialysis | 6,409 | 235,402 | 37 |
Source: CMS Market Saturation & Utilization, NATION + TERRITORIES aggregation, 2025 reference period, by average users per provider.
At one end, 2,303 independent clinical laboratories reach 15.6 million beneficiaries — 6,754 each — and 3,883 diagnostic-testing facilities reach 16.7 million, 4,312 each. A few thousand high-throughput facilities account for two of the three widest-reaching services in the entire program. At the other end, physical therapists average 40 beneficiaries each and dialysis providers 37, because those services are delivered face-to-face by tens of thousands of practitioners. This is the same contrast the saturation map shows from the supply side — a handful of facility-based services versus a long tail of office-based ones — read here from the demand side. The 184-fold spread is structural: it describes how each service is organized, not how well any provider performs.
Who shows up: the dual-eligible mix
The file also records, for each service, how many of its users are dual-eligible — covered by both Medicare and Medicaid, and generally the lowest-income part of the Medicare population. The dual share is a rough map of which services reach the poorest beneficiaries.
| Service | Beneficiaries reached | Dual-eligible users | Dual share |
|---|---|---|---|
| Federally Qualified Health Center | 1,492,047 | 606,466 | 40.7% |
| Dialysis | 235,402 | 80,518 | 34.2% |
| Psychotherapy | 2,108,821 | 547,860 | 26.0% |
| Telemedicine | 1,375,348 | 347,465 | 25.3% |
| Ambulance (non-emergency) | 1,323,893 | 333,214 | 25.2% |
| Skilled nursing facility | 1,141,379 | 275,248 | 24.1% |
| Home health | 2,613,941 | 484,617 | 18.5% |
| Durable medical equipment | 7,358,733 | 1,015,788 | 13.8% |
| Preventive health services | 21,248,672 | 2,300,831 | 10.8% |
| Ophthalmology | 12,283,238 | 1,094,170 | 8.9% |
| Physical & occupational therapy | 3,839,619 | 303,478 | 7.9% |
| Chiropractic services | 1,329,758 | 58,405 | 4.4% |
Source: CMS Market Saturation & Utilization, NATION + TERRITORIES aggregation, 2025 reference period, by dual-eligible share of users.
Federally Qualified Health Centers top the list at 40.7% — four in ten of their Medicare users are also on Medicaid, against roughly one in nine across the program. FQHCs exist to serve low-income communities, and the dual share confirms it. Dialysis (34.2%), psychotherapy (26.0%), telemedicine, non-emergency ambulance, and skilled nursing all run well above the program baseline — services that, for different reasons, concentrate among low-income and chronically ill beneficiaries. Discretionary office services sit at the bottom: chiropractic at 4.4%, physical therapy at 7.9%. The figure is a description of who reaches which service, not a judgment about any of them.
The same service reaches very different shares by state
Even Medicare's single most-used service does not reach beneficiaries evenly. Roll preventive-health use up to the state level and the penetration rate ranges from 67.6% in Delaware to 43.3% in Maine — a 24.3-point gap around the national 53.6%.
| State | Share of FFS using preventive care | |
|---|---|---|
| Highest | Delaware | 67.6% |
| South Carolina | 62.0% | |
| Massachusetts | 60.4% | |
| Maryland | 59.4% | |
| New Jersey | 59.3% | |
| Lowest | Hawaii | 45.4% |
| Idaho | 44.8% | |
| Alaska | 44.6% | |
| Oregon | 44.1% | |
| Maine | 43.3% |
Source: CMS Market Saturation & Utilization, STATE aggregation, preventive health services, 2025 reference period, states with at least 100,000 FFS beneficiaries.
The high end is mid-Atlantic and Southeastern; the low end is rural and Western, with Maine, Vermont, and Oregon trailing. A penetration gap like this is a reach signal, not a verdict — it can reflect how managed care, provider supply, coding practice, and population health differ between states. What it shows plainly is that even the service Medicare's population uses most reaches barely four in ten beneficiaries in some states and two in three in others.
What one row actually is
Each row in cms_market_saturation is one market: a county, state, or the nation, for one service category, in one reference period, carrying its provider count, its FFS-beneficiary count, the number of those beneficiaries who used the service, the average users per provider, the dual-eligible counts, the total fee-for-service payment, and the moratorium flag. This study reads the users side of that row — penetration, caseload, and dual mix — where the saturation study read the providers side. The data CMS publishes is aggregate by construction: it reports how many beneficiaries used a service in a market, never which ones, so no count or share in this study names, ranks, or scores any individual beneficiary, agency, supplier, or clinician. The unit of analysis is the market, not the person.
Methodology
All figures are aggregations over the cms_market_saturation table, populated from the CMS Market Saturation & Utilization State-County files published through the CMS data catalog (data.cms.gov, Program Integrity > Market Saturation by Type of Service). The table holds 1,030,290 rows spanning 15 yearly reference periods (2020 through 2025), 24 service categories, and three aggregation levels — NATION + TERRITORIES, STATE, and COUNTY. Snapshot release 2025-12-01; public, read-only; license US-Government-Works.
This study reads only the most recent annual period — reference_period = '2025-01-01 to 2025-12-31', 68,068 records, of which 24 are NATION + TERRITORIES rollups — resolved as max(reference_period) at query time rather than hard-coded, so the figures advance when CMS publishes the next file. Penetration is number_of_users / number_of_ffs_beneficiaries (CMS stores the same value as percentage_users_of_ffs), computed per row. Caseload is the reported average_users_per_provider. The dual share is number_of_dual_eligible_users / number_of_users (stored as percentage_dual_of_total_users). State figures read aggregation_level = 'STATE' and are limited to states with at least 100,000 FFS beneficiaries so small-state ratios do not distort the ranking. Because these are direct counts and ratios over a published aggregate table, every figure is exact as of the snapshot rather than estimated. Methodology version: market-saturation/v1. The source-provenance contract is documented in the provenance methodology.
Limitations
- A reach measure, not a quality or volume measure. Penetration is the share of beneficiaries who used a service. It says nothing about how good the care was, whether the volume was appropriate, or how much was billed. A high or low share is descriptive, never an assessment of any provider or any market.
- Aggregate and geography-level only. The CMS files are aggregate by construction. Every figure here is a count or share at the service, state, or national level; no individual beneficiary, agency, supplier, or clinician is named, ranked, or scored.
- Users count beneficiaries, not encounters. The users column counts distinct beneficiaries who used a service in the period, not visits, claims, or dollars. A service can reach few people intensively or many people lightly; penetration does not distinguish the two.
- Caseload reflects how a service is organized. Average users per provider is high for facility-based services that process orders centrally (labs, diagnostic-testing facilities) and low for face-to-face office services (therapy, chiropractic). The 184-fold spread describes service structure, not provider productivity or performance.
- Dual share is a population marker, not a means test. The dual-eligible share indicates how concentrated a service's users are among beneficiaries who also have Medicaid. It is a rough proxy for low income and carries no judgment about the service or its users.
- Snapshot, not a trend. Figures reflect the most recent annual period in the 2025-12-01 snapshot. CMS revises and extends the series, so shares shift between releases; this study does not model change over time.
- Fee-for-service only. The file covers Medicare fee-for-service beneficiaries. It does not describe Medicare Advantage enrollees, whose utilization is not reported here, so the shares are not statements about the whole Medicare population.
Sources
- CMS — Market Saturation by Type of Service (Program Integrity) — the State-County public-use files behind every figure in this study.
- CMS — Market Saturation & Utilization State-County tool — CMS's interactive map and the agency's own description of the saturation and utilization measures.
- CMS — Dual eligible beneficiaries under Medicare and Medicaid — background on the dual-eligible population the dual-share column reports.
The companion dataset page for CMS Market Saturation lists the full schema and refresh cadence. This is the demand-side mirror of where Medicare providers cluster thickest; for who is enrolled to bill Medicare in the first place see the changing shape of Medicare enrollment, for the access end of the same system the rural care deserts where providers are scarcest and the coverage mix at America's community health centers, and for who steps outside the program entirely, the behavioral-health story behind Medicare opt-outs.
Frequently asked questions
- What does Medicare 'utilization' mean in this data?
- Utilization here is the share of fee-for-service beneficiaries who actually used a given service in the year — providers per market is the saturation measure, but the users column counts the people on the receiving end. Divide the number of users by the number of FFS beneficiaries and you get a penetration rate: what fraction of Medicare's population a service reaches. CMS publishes both halves in the same Market Saturation & Utilization file.
- Which Medicare service reaches the most beneficiaries?
- Preventive health services. In 2025 it reached 21.2 million of Medicare's 39.6 million fee-for-service beneficiaries — 53.6%, the only one of 24 service categories that reaches more than half. Independent diagnostic-testing facilities (42.3%) and clinical laboratories (39.3%) follow. Most categories reach far fewer people: the median service touches under 6% of beneficiaries, and seventeen of the twenty-four reach under 10%.
- Why do clinical labs serve thousands of beneficiaries each while therapists serve dozens?
- Because they are built differently. Independent clinical laboratories and diagnostic-testing facilities are a small number of high-throughput facilities — 2,303 labs and 3,883 testing facilities nationally — that process specimens and orders for a huge share of the program, 6,754 and 4,312 beneficiaries each. Office-based clinical services like physical therapy, chiropractic, and psychotherapy are delivered face-to-face by tens of thousands of practitioners, so each one carries 40 to 60 beneficiaries. The 184-fold gap is a structural feature of how each service is organized, not a quality difference.
- Does high or low utilization mean a service is good or bad?
- Neither. Utilization is a reach measure. A high share means a service touches many beneficiaries; a low share can mean it is specialized (dialysis, long-term care hospitals), discretionary (chiropractic), or hard to access. It says nothing about the quality of the care, whether the volume is appropriate, or how much was billed. This study reports geography- and service-level shares only and names no provider.
- What is the dual-eligible share, and why does it vary so much?
- Dual-eligibles are beneficiaries covered by both Medicare and Medicaid — generally the lowest-income part of the Medicare population. The data reports, for each service, what share of its users are dual-eligible. That share is highest at Federally Qualified Health Centers (40.7%), dialysis (34.2%), and psychotherapy (26.0%) — services that disproportionately reach low-income beneficiaries — and lowest for chiropractic (4.4%) and physical therapy (7.9%). It is a map of who reaches which service, not a judgment about any of them.
- Can I reproduce these figures?
- Yes. Every number aggregates the public cms_market_saturation table — the CMS Market Saturation & Utilization State-County files, snapshot release 2025-12-01 — over its most recent annual period. The exact SQL for the national penetration ranking, the caseload spread, the dual-eligible mix, and the state-level preventive-care variation is published in the reproducibility block below.
Who uses this data
The source data behind this study is public
Compliance teams, journalists, and researchers work from the same federal source families cited above — queried by NPI or facility identifier through Fonteum’s open dataset pages and API. Every figure traces to a frozen, downloadable snapshot you can reproduce yourself.
Datasets used
Reproducibility
Every claim, reproducible
The SQL
-- What Medicare actually USES — the demand-side (Utilization) half of the CMS
-- Market Saturation & Utilization file. Fully reproducible query.
--
-- Question: of the 24 Medicare fee-for-service service categories CMS tracks,
-- how much of the beneficiary population does each one actually reach
-- (penetration), how many beneficiaries does each provider carry (caseload),
-- and which services concentrate among low-income dual-eligible beneficiaries?
-- The lead figure: preventive health services reaches 53.6% of FFS
-- beneficiaries — the ONLY category above half — while the median category
-- reaches under 6%. Utilization is a REACH measure: it says nothing about the
-- quality of care, the volume billed, or any provider's conduct.
--
-- Source:
-- public.cms_market_saturation — CMS "Market Saturation & Utilization
-- State-County" public-use files, published via the CMS data catalog
-- (data.cms.gov, Program Integrity > Market Saturation by Type of Service).
-- 1,030,290 rows across 15 yearly reference periods (2020–2025), 24 service
-- categories, three aggregation levels (NATION + TERRITORIES, STATE,
-- COUNTY). Snapshot release 2025-12-01. Public, read-only.
-- License: US-Government-Works (17 U.S.C. Sec. 105).
-- methodology_version = 'market-saturation/v1'.
--
-- Period: this study reads only the MOST RECENT annual period, resolved as
-- max(reference_period) rather than hard-coded, so figures advance when CMS
-- publishes the next file. Latest = '2025-01-01 to 2025-12-31', 68,068 rows
-- (24 NATION + TERRITORIES rollups, 1,219 STATE, 66,825 COUNTY).
--
-- Counting note: "users" counts DISTINCT beneficiaries who used a service in
-- the period — not visits, claims, or dollars. Penetration = users / FFS
-- beneficiaries. The data is aggregate by construction: no individual
-- beneficiary or provider appears, and none is named in the study.
-- ============================================================================
-- (0) Universe reconciliation — the table and the latest period at a glance.
-- ============================================================================
SELECT
count(*) AS total_rows,
count(DISTINCT reference_period) AS periods,
count(DISTINCT type_of_service) AS services,
max(reference_period) AS latest_period,
max(source_release_date) AS release
FROM public.cms_market_saturation;
-- total_rows 1,030,290 · periods 15 · services 24
-- latest_period '2025-01-01 to 2025-12-31' · release 2025-12-01
SELECT
count(*) AS latest_period_rows,
count(*) FILTER (WHERE aggregation_level ILIKE 'NATION%') AS nation_rows,
count(*) FILTER (WHERE aggregation_level ILIKE 'STATE%') AS state_rows,
count(*) FILTER (WHERE aggregation_level ILIKE 'COUNTY%') AS county_rows
FROM public.cms_market_saturation
WHERE reference_period = '2025-01-01 to 2025-12-31';
-- latest_period_rows 68,068 · nation 24 · state 1,219 · county 66,825
-- ============================================================================
-- (1) HEADLINE: penetration by service (national). Share of FFS beneficiaries
-- who actually USE each service. Only preventive health clears 50%; the
-- median category reaches under 6%; 17 of 24 reach under 10%.
-- ============================================================================
SELECT
type_of_service,
number_of_providers AS providers,
number_of_users AS beneficiaries_reached,
number_of_ffs_beneficiaries AS ffs,
round(100.0 * number_of_users
/ nullif(number_of_ffs_beneficiaries, 0), 1) AS pct_users_of_ffs
FROM public.cms_market_saturation
WHERE reference_period = '2025-01-01 to 2025-12-31'
AND aggregation_level ILIKE 'NATION%'
ORDER BY number_of_users DESC;
-- Preventive Health Services 225,876 21,248,672 39,609,673 53.6% <- only category > 50%
-- Indep. Diagnostic Testing Facility A 3,883 16,742,549 39,608,339 42.3%
-- Clinical Laboratory (Billing Indep.) 2,303 15,554,744 39,608,749 39.3%
-- Ophthalmology 47,498 12,283,238 39,604,303 31.0%
-- Pulmonology 180,428 9,326,391 39,602,413 23.6%
-- Durable Medical Equipment 45,963 7,358,733 39,598,270 18.6%
-- Podiatry Services 15,172 4,425,256 39,532,230 11.2%
-- Physical & Occupational Therapy 95,124 3,839,619 39,522,162 9.7%
-- Home Health 8,488 2,613,941 39,524,879 6.6%
-- Psychotherapy 35,557 2,108,821 39,480,134 5.3%
-- Skilled Nursing Facility 12,919 1,141,379 39,391,060 2.9%
-- Hospice 5,024 915,164 39,475,379 2.3%
-- Dialysis 6,409 235,402 38,046,460 0.6%
-- (… 24 categories total; tail includes Endocrinology 0.7%, Neurology 1.2%,
-- Cardiac Rehab 0.5%, Long-Term Care Hospitals 0.1%.)
-- Distribution summary — confirms "only one over 50%, median under 6%".
SELECT
count(*) AS services,
count(*) FILTER (WHERE percentage_users_of_ffs > 50) AS over_50pct,
count(*) FILTER (WHERE percentage_users_of_ffs >= 10) AS at_least_10pct,
count(*) FILTER (WHERE percentage_users_of_ffs < 10) AS under_10pct,
round(percentile_cont(0.5) WITHIN GROUP
(ORDER BY percentage_users_of_ffs)::numeric, 2) AS median_pct
FROM public.cms_market_saturation
WHERE reference_period = '2025-01-01 to 2025-12-31'
AND aggregation_level ILIKE 'NATION%';
-- services 24 · over_50pct 1 · at_least_10pct 7 · under_10pct 17 · median_pct 5.98
-- ============================================================================
-- (2) CASELOAD: average users per provider (national). A handful of facility-
-- based services carry thousands of beneficiaries each; office-based
-- services carry dozens. The spread runs 6,754 (labs) to 37 (dialysis),
-- a factor of ~184.
-- ============================================================================
SELECT
type_of_service,
number_of_providers AS providers,
number_of_users AS beneficiaries_reached,
average_users_per_provider AS users_per_provider
FROM public.cms_market_saturation
WHERE reference_period = '2025-01-01 to 2025-12-31'
AND aggregation_level ILIKE 'NATION%'
ORDER BY average_users_per_provider DESC;
-- Clinical Laboratory 2,303 15,554,744 6,754
-- Indep. Diagnostic Testing Facility A 3,883 16,742,549 4,312
-- Ambulance (Emergency & Non-Emergency)8,504 3,752,418 441
-- Home Health 8,488 2,613,941 308
-- Ophthalmology 47,498 12,283,238 259
-- Hospice 5,024 915,164 182
-- Durable Medical Equipment 45,963 7,358,733 160
-- Psychotherapy 35,557 2,108,821 59
-- Pulmonology 180,428 9,326,391 52
-- Chiropractic Services 25,597 1,329,758 52
-- Physical & Occupational Therapy 95,124 3,839,619 40
-- Dialysis 6,409 235,402 37 <- lowest
-- max/min = 6,754 / 37 = 184x
-- ============================================================================
-- (3) DUAL-ELIGIBLE MIX: share of each service's users who are dual-eligible
-- (Medicare + Medicaid), a marker of the low-income population. FQHCs top
-- the list at 40.7%; chiropractic is lowest at 4.4%. Services with > 200k
-- users shown so small-base ratios do not distort the ranking.
-- ============================================================================
SELECT
type_of_service,
number_of_users AS beneficiaries_reached,
number_of_dual_eligible_users AS dual_users,
percentage_dual_of_total_users AS dual_share_pct
FROM public.cms_market_saturation
WHERE reference_period = '2025-01-01 to 2025-12-31'
AND aggregation_level ILIKE 'NATION%'
AND number_of_users > 200000
ORDER BY percentage_dual_of_total_users DESC NULLS LAST;
-- Federally Qualified Health Center 1,492,047 606,466 40.65% <- highest
-- Dialysis 235,402 80,518 34.20%
-- Psychotherapy 2,108,821 547,860 25.98%
-- Telemedicine 1,375,348 347,465 25.26%
-- Ambulance (Non-Emergency) 1,323,893 333,214 25.17%
-- Skilled Nursing Facility 1,141,379 275,248 24.12%
-- Home Health 2,613,941 484,617 18.54%
-- Durable Medical Equipment 7,358,733 1,015,788 13.80%
-- Preventive Health Services 21,248,672 2,300,831 10.83%
-- Ophthalmology 12,283,238 1,094,170 8.91%
-- Physical & Occupational Therapy 3,839,619 303,478 7.90%
-- Chiropractic Services 1,329,758 58,405 4.39% <- lowest
-- ============================================================================
-- (4) GEOGRAPHIC VARIATION: preventive-care penetration by state (the single
-- most-used service). Even it ranges from 67.6% (DE) to 43.3% (ME) —
-- a 24.3-point gap around the national 53.6%. States with >= 100k FFS
-- beneficiaries only, so small-state ratios do not distort the ranking.
-- ============================================================================
WITH s AS (
SELECT
state,
percentage_users_of_ffs AS pen,
number_of_users AS users,
number_of_ffs_beneficiaries AS ffs
FROM public.cms_market_saturation
WHERE reference_period = '2025-01-01 to 2025-12-31'
AND aggregation_level ILIKE 'STATE%'
AND type_of_service = 'Preventive Health Services'
AND number_of_ffs_beneficiaries > 100000
)
(SELECT 'HIGH' AS tag, state, pen, users, ffs FROM s ORDER BY pen DESC LIMIT 5)
UNION ALL
(SELECT 'LOW' AS tag, state, pen, users, ffs FROM s ORDER BY pen ASC LIMIT 5)
ORDER BY tag, pen DESC;
-- HIGH DE 67.58 · SC 61.95 · MA 60.42 · MD 59.37 · NJ 59.32
-- LOW HI 45.36 · ID 44.78 · AK 44.64 · OR 44.07 · ME 43.34
-- national preventive-health penetration = 53.6%; gap of the displayed rounded
-- state rates 67.6 - 43.3 = 24.3 points (raw 67.58 - 43.34 = 24.24)The snapshot
| dataset_id | cms-provider-data-catalog |
| snapshot_date | 2026-06-16 |
| sha256 | |
| doi | 10.5072/fonteum/medicare-utilization-penetration-2026 |
| slsa_provenance_url |
The JOINs
period: reference_period = max(reference_period) -- latest annual period 2025-01-01..2025-12-31, 68,068 rows penetration = number_of_users / number_of_ffs_beneficiaries (= percentage_users_of_ffs) -- share of FFS beneficiaries using a service, per row national rows: aggregation_level = 'NATION + TERRITORIES', 24 service categories -- preventive health 53.6%, only category > 50%; median 5.98% caseload = average_users_per_provider -- clinical lab 6,754 / IDTF Pt A 4,312 high; PT/OT 40 / dialysis 37 low (184x) dual mix = number_of_dual_eligible_users / number_of_users (= percentage_dual_of_total_users) -- FQHC 40.7% highest, chiropractic 4.4% lowest state penetration: aggregation_level = 'STATE', type_of_service = 'Preventive Health Services' -- DE 67.6% high, ME 43.3% low, ≥100k FFS users are distinct beneficiaries who used the service, not visits or claims -- penetration is a reach measure, never a volume or spending measure
The pipeline version
| git_sha | |
| slsa_provenance | |
| methodology_version | market-saturation/v1 |
Reproduce this
Run the exact query against the frozen 2026-06-16.
Cite this study
Citation-ready for researchers and AI.
Check the chain
Each figure is snapshot-attested — re-derive the hash from the federal file.
cms-provider-data-catalog · 2026-06-16SHA-256 a3f1c9…7e6b- ACCESS · JUN 2026Where Medicare providers cluster: home health and DME market saturation, 2025In Los Angeles County, 1,847 home health agencies serve Medicare's fee-for-service population — the most of any U.S. county, at 2.12 per 1,000 beneficiaries, nearly ten times the national rate of 0.22. CMS publishes this market-saturation map for program-integrity monitoring, not as proof of fraud.
- ACCESS · JUN 2026Who opts out of Medicare: a behavioral-health story, 2026Of the 56,117 clinicians on CMS's Medicare opt-out list, 60.9% belong to five behavioral-health specialties — psychologists, social workers, mental health counselors, marriage-and-family therapists, and psychiatrists. The largest single year was 2024, when 15,978 opted out, two-thirds of them therapists Congress had just made Medicare-eligible.
- ACCESS · JUN 2026America's care deserts are rural: two-thirds of U.S. health-care shortage areasTwo-thirds of America's active health-care shortage areas are rural: 13,999 of the 21,133 designated Health Professional Shortage Areas — 66.2% — sit in rural communities, against 6,069 non-rural ones. The rural skew holds across primary care (66.0%), mental health (65.3%), and dental health (67.4%) alike, spanning 25,281 federal designations in 60 jurisdictions.
- ACCESS · JUN 2026Where the uninsured land: coverage at America's community health centers, 202466.2% of the 32.4 million patients at America's community health centers were uninsured or on Medicaid in 2024. But the mix flips by state: Texas centers reported 33.6% of patients uninsured against 29.8% on Medicaid; California centers, 10.1% uninsured and 72.0% on Medicaid.
- WORKFORCE · JUN 2026Who is enrolled in Medicare? The nurse practitioner is now the most common clinician413,539 nurse practitioner enrollments make NPs the single most common clinician type in Medicare's provider-enrollment file — 13.9% of all 2.98 million PECOS records, nearly triple the largest physician specialty. Together, NPs and physician assistants are one in five enrollments. Advanced-practice providers now anchor the Medicare workforce.
Federal source citations
Fonteum Research · June 16, 2026 · All figures trace to the frozen federal-data snapshot cited above.