Medicare Consulting Service Market Report 2025

The medicare consulting service market size has grown strongly in recent years. It will grow from $7.81 billion in 2024 to $8.43 billion in 2025 at a compound annual growth rate (CAGR) of 8%. Growth during the historic period was driven by an expanding aging population, increasing Medicare enrollment rates, rising demand for plan guidance, greater awareness of healthcare costs, and growing complexity in coverage options.

The medicare consulting service market size is expected to see strong growth in the next few years. It will grow to $11.32 billion in 2029 at a compound annual growth rate (CAGR) of 7.6%. Growth in the forecast period is expected to result from the increasing need for compliance support, rising prevalence of chronic diseases, growing demand for virtual consulting services, expanding retiree health planning requirements, and frequent policy regulation updates. Key trends anticipated during this period include advancements in telehealth consulting platforms, the integration of AI for plan matching, increased technology adoption in claims assistance, the development of personalized plan analytics, and innovations in compliance automation tools.

The increasing adoption of value-based care models is expected to drive the growth of the Medicare consulting service market in the coming years. Value-based care models are healthcare systems in which providers are compensated based on patient health outcomes, focusing on quality, efficiency, and preventive care rather than service volume. This shift from volume-based to outcome-based reimbursement is accelerating as providers and payers work to improve patient outcomes while managing healthcare costs. Medicare consulting services support value-based care by advising healthcare providers on compliance, reimbursement, and operational strategies. These services help organizations implement outcome-driven practices and optimize care delivery, ultimately improving patient outcomes and cost efficiency. For example, in October 2023, according to America’s Health Insurance Plans (AHIP), a US-based health insurance association, 86.7% of people in the US were enrolled in value-based care arrangements in 2022, up from 77% in 2021. Therefore, the growing adoption of value-based care models is fueling the expansion of the Medicare consulting service market.

Companies operating in the Medicare consulting service sector are developing advanced solutions, such as comprehensive risk adjustment workflow systems, to improve reimbursement accuracy, compliance, and care quality. An end-to-end risk adjustment workflow solution is a system that oversees the complete process of assessing, documenting, and coding patient health data to accurately estimate healthcare costs and maximize reimbursements. For instance, in March 2025, Milliman MedInsight Inc., a US-based healthcare analytics and consulting firm, introduced the Milliman MedInsight risk adjustment platform, a comprehensive solution designed to help healthcare organizations manage risk adjustment processes efficiently. The platform combines advanced analytics, retrospective chart review, and prospective encounter gap closure tools into a unified workflow, streamlining operations and improving the precision of patient risk scores for Medicare Advantage and other risk-based payment models. This solution plays a key role in ensuring fair compensation for care provided, highlighting its strategic importance.

In February 2024, Chartis Group LLC, a US-based healthcare consulting firm, acquired HealthScape Advisors LLC for an undisclosed amount. This acquisition aims to strengthen Chartis’s expertise in the healthcare payer sector and enhance its ability to assist payers and providers in managing transformational change in an evolving healthcare environment. HealthScape Advisors LLC is a US-based consulting firm specializing in Medicare consulting services.

Major players 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.

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 medicare consulting service market report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East and Africa. The countries covered in the medicare consulting service market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA, Canada, Italy, Spain.

Note that the outlook for this market is being affected by rapid changes in trade relations and tariffs globally. The report will be updated prior to delivery to reflect the latest status, including revised forecasts and quantified impact analysis. The report’s Recommendations and Conclusions sections will be updated to give strategies for entities dealing with the fast-moving international environment.

The sudden escalation of U.S. tariffs and the consequent trade frictions in spring 2025 are severely impacting the healthcare sector, particularly in the supply of critical medical devices, diagnostic equipment, and pharmaceuticals. Hospitals and healthcare providers are facing higher costs for imported surgical instruments, imaging equipment, and consumables such as syringes and catheters, many of which have limited domestic alternatives. These increased costs are straining healthcare budgets, leading some providers to delay equipment upgrades or pass on expenses to patients. Additionally, tariffs on raw materials and components are disrupting the production of essential drugs and devices, causing supply chain bottlenecks. In response, the industry is diversifying sourcing strategies, boosting local manufacturing where possible, and advocating for tariff exemptions on life-saving medical products.

A medicare consulting service refers to professional support that assists individuals, businesses, or healthcare providers in navigating Medicare by providing guidance on eligibility, plan selection, cost management, compliance, and claims support, ensuring informed choices and optimal benefits.

The primary types of medicare consulting services include enrollment assistance, claims assistance, plan selection, and compliance and regulatory support. Enrollment assistance helps individuals understand, complete, and submit applications for programs or benefits, ensuring they meet eligibility criteria and deadlines. These services can be delivered either online or offline and are utilized in various applications such as individual Medicare programs and employer group programs, serving key end users including individuals, insurance companies, healthcare providers, and others.

The medicare consulting services market research report is one of a series of new reports that provides medicare consulting services market statistics, including the medicare consulting services industry global market size, regional shares, competitors with the medicare consulting services market share, detailed medicare consulting services market segments, market trends, and opportunities, and any further data you may need to thrive in the medicare consulting services industry. This medicare consulting services market research report delivers a complete perspective of everything you need, with an in-depth analysis of the current and future scenarios of the industry.

The medicare consulting service market includes revenues earned by entities through claims management support, plan selection, cost and coverage evaluation, policy review, and beneficiary support services. The market value includes the value of related goods sold by the service provider or included within the service offering. Only goods and services traded between entities or sold to end consumers are included.

The market value is defined as the revenues that enterprises gain from the sale of goods and/or services within the specified market and geography through sales, grants, or donations in terms of the currency (in USD unless otherwise specified).

The revenues for a specified geography are consumption values that are revenues generated by organizations in the specified geography within the market, irrespective of where they are produced. It does not include revenues from resales along the supply chain, either further along the supply chain or as part of other products.

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