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Unlocking Opportunities in the Medicare Consulting Service Market: 2025-2034 Forecast Report
Medicare Consulting Service Market
What Will the Medicare Consulting Service Industry Market Size Be by 2025?
The market size of the medicare consulting service has seen considerable expansion in the preceding years. The market, which is currently valued at $7.81 billion in 2024, is projected to reach $8.43 billion in 2025 with a compound annual growth rate (CAGR) of 8.0%. Several factors have powered this past growth including an escalating elderly population, increased rate of Medicare enrolment, the mounting need for plan counselling, a growing awareness of healthcare expenses, and the enhancement of intricacies in coverage options.
What's the Long-Term Growth Forecast for the Medicare Consulting Service Market Size Through 2029?
In the coming years, the medicare consulting service market is predicted to experience significant expansion, reaching a value of $11.32 billion in 2029 with a compound annual growth rate (CAGR) of 7.6%. This anticipated growth through the forecast period is due to factors such as increasing requirements for compliance support, the escalating prevalence of chronic illnesses, a surge in the need for virtual consultations, the growing needs for health planning among retirees, and consistent updates in policy regulations. Additionally, the forecast period is expected to see key trends like progress in telehealth consulting platforms, the integration of AI in plan matching, the increased adoption of technology in claims assistance, advancements in personalized plan analytics, and the modernization of compliance automation tools.
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What Are the Key Growth Drivers Fueling the Medicare Consulting Service Market Expansion?
The expectation for the medicare consulting service market to expand is attributed to the rising acceptance of value-based care models. These models are healthcare systems that compensate providers based on patient health outcomes, prioritizing quality, efficiency, and preventive care instead of service volume. As the preference is shifting from volume-based to outcome-based reimbursement, the usage of value-based care models sees an upward trend. This shift is guided by the goal of providers and payers to enhance patient outcomes while keeping healthcare costs in check. Medicare consulting services accentuate value-based care by advising healthcare providers on areas like compliance, reimbursement, and operational strategies. These services bolster patient outcomes and care efficiency by aiding organizations in implementing outcome-based practices and fine-tuning healthcare delivery. For example, according to America's Health Insurance Plans (AHIP), a health insurance association based in the US, there was a rise in the number of people in the US covered under value-based care arrangements, reaching 86.7% in 2022, a significant increase from 77% the previous year. Consequently, the increasing acceptance of value-based care models is fueling the growth of the medicare consulting service market.
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Which Emerging Trends Are Transforming the Medicare Consulting Service Market in 2025?
Leading firms in the medicare consulting service sector are concentrating on creating high-tech solutions, particularly comprehensive risk adjustment workflow systems, to amplify the accuracy of reimbursements, compliance, and care quality. An end-to-end risk adjustment workflow solution is an all-encompassing platform that oversees the full procedure of evaluating, documenting, and coding the health data of patients to predict healthcare costs precisely and maximize reimbursements. For instance, in March 2025, the healthcare analytics and consulting company based in the US, Milliman MedInsight Inc., introduced the Milliman MedInsight risk adjustment platform. This platform is an all-encompassing, end-to-end system designed to bolster healthcare organizations' capacity to manage risk adjustment procedures efficiently. The platform combines advanced analytics, retrospective chart evaluation, and prospective encounter gap closure instruments into a single workflow, simplifying operations and enhancing the precision of patient risk scores for Medicare Advantage and other risk-dependent payment models. It is pivotal in ensuring adequate compensation for the care provided, emphasizing the platform's strategic importance.
How Is the Medicare Consulting Service Market Segmented?
The medicare consulting service market covered in this report is segmented
1) By Service Type: Enrollment Assistance, Claims Assistance, Plan Selection, Compliance And Regulatory Assistance
2) By Mode Of Delivery: Online, Offline
3) By Application: Individual Medicare Programs, Employer Group Programs
4) By End-User: Individuals, Insurance Companies, Healthcare Providers, Other End-Users
Subsegments:
1) By Enrollment Assistance: Medicare Initial Enrollment Support, Special Enrollment Period Guidance, Part D Enrollment Services, Medicare Advantage Plan Enrollment, Enrollment Education And Workshops
2) By Claims Assistance: Billing Error Resolution Support, Claims Submission Guidance, Denied Claims Appeal Support, Out-Of-Pocket Cost Explanation, Claims Tracking And Updates
3) By Plan Selection: Medicare Advantage Plan Comparison, Medigap Policy Evaluation, Prescription Drug Plan Matching, Cost-Benefit Plan Analysis, Personalized Coverage Recommendations
4) By Compliance And Regulatory Assistance: Health Insurance Portability and Accountability Act of 1996 (HIPAA) Compliance Guidance, Content Management System (CMS) Regulation Updates Support, Audit Preparation And Review, Policy Documentation Assistance, Fraud Prevention Education
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Which Companies Are Leading the Charge in Medicare Consulting Service Market Innovation?
Major companies operating in the medicare consulting service market are accenture* plc, Deloitte Touche Tohmatsu Limited, PricewaterhouseCoopers International Limited, Ernst & Young Global Limited, Klynveld Peat Marwick Goerdeler, General Electric Healthcare Partners, IQVIA Holdings Inc., McKinsey & Company Inc., Boston Consulting Group Inc., L.E.K. Consulting LLC, Bain & Company Inc., Milliman Inc., Huron Consulting Group Inc., Astron Hospital And Healthcare Consultants Pvt., ATTAC Consulting, Fair Square Medicare, Healthcare Navigation LLC, Hovis & Associates LLC, Keystone Benefits Group Inc., and USA Medicare Consultants LLC.
Which Regions Are Leading the Global Medicare Consulting Service Market in Revenue?
North America was the largest region in the medicare consulting service market in 2024. Asia-Pacific is expected to be the fastest-growing region in the forecast period. The regions covered in the medicare consulting service market report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East, Africa.
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