Dr. Lee Revere

If you watch television, listen to the radio or use the internet, it’s hard to miss advertisements for Medicare Advantage plans. Fall is open enrollment time when all Medicare enrollees can join, drop or switch from traditional Medicare to Medicare Advantage plans, or vice versa. In January, Medicare Advantage members can again choose to switch Advantage plans or return to traditional Medicare. Health care services expert Lee Revere, Ph.D., a professor and Florida Blue Endowed Chair of the department of health services research, management and policy at the College of Public Health and Health Professions, offers insights to help you or a loved one understand Medicare Advantage and changes on the horizon for next year.

Question: What is Medicare Advantage?

Answer: Americans age 65 or older can choose to receive federal Medicare health insurance benefits through original Medicare, also known as traditional Medicare, in which the government pays for covered health care services, or through Medicare Advantage. Medicare Advantage health insurance plans are provided by Medicare-approved private companies. Medicare pays these companies to provide health care coverage. According to the Kaiser Family Foundation, Medicare Advantage enrollment is projected to grow from 54% of the eligible population in 2024 to 60% by the end of 2030.

Medicare Advantage plan users are required to have Part A and Part B of traditional Medicare. Part A covers hospital stays while Part B covers medical services delivered by outpatient providers. Although original Medicare covers inpatient and outpatient services, beneficiaries share costs via deductibles and co-insurance. To offset those costs, some beneficiaries buy Medigap insurance to cover the payment “gaps,” as well as Medicare Part D for prescription drug coverage.

Medicare Advantage plans offer benefits beyond those provided by Medicare Part A and B, including dental, vision and wellness plans. In addition, Medicare Advantage enrollees do not need Medigap insurance and usually do not need Part D.

Q: Why should someone consider Medicare Advantage?

A: So why join a Medicare Advantage plan? The short answer is the extra benefits that don’t come with traditional Medicare. For example, most plans don’t require a premium while providing additional wellness and prescription benefits. Given the rising costs of Medigap plans and Medicare Part D, beneficiaries on Medicare Advantage plans can often save money on insurance costs. Also, many large employers and states are now offering Medicare Advantage plans for retiree health coverage, with some providing this as the only option.

Q: What rules are in place to protect consumers?

A: Medicare beneficiaries often use brokers to help them navigate the numerous Medicare Advantage plans. These brokers are provided compensation, and sometimes other financial incentives, for each enrollee that enrolls in a plan. Beginning in 2025, a new Centers for Medicare & Medicaid Services, or CMS, rule prohibits brokers from earning additional financial incentives for recommending one plan over another. This new rule will ensure brokers work with clients to identify the plan that best fits their needs, and will likely require Medicare Advantage plans to better articulate their offerings relative to their competitors.

Another upcoming change is notification of unused supplemental benefits. Studies have shown the majority of Medicare beneficiaries select Medicare Advantage plans based on the supplemental benefits, such as dental, vision, hearing and fitness. However a 2024 Commonwealth Fund study showed 30% of Medicare Advantage beneficiaries do not use those benefits. In 2025, CMS is requiring all Medicare Advantage plans to provide mid-year notification of unused supplement benefits to all members. Considering CMS pays the Medicare Advantage plans in excess of the average Medicare beneficiary cost, it makes sense they would want beneficiaries to reap the benefits.

Q: How does someone avoid picking the wrong Medicare Advantage plan?

A: I am not sure any plan is wrong or flawed. There are plans that are better for different individuals. Medicare beneficiaries need to consider how they use health care, their financial constraints and their willingness to use in-network providers. Medicare Advantage plans can often save beneficiaries money if they have high dental, vision or medication costs with original Medicare. However, Medicare Advantage plans often require referrals and preauthorization for services which can sometimes delay or deny care. Eligible beneficiaries should also consider if they travel frequently, particularly internationally. Some Medicare Advantage plans may not cover beneficiaries who are out of the service area for long periods.

Additional resources:

• Medicare’s one-page summary of the differences between original Medicare and Medicare Advantage.
• AARP’s short article discussing original Medicare and Medicare Advantage plans.
• Medicare offers a comprehensive review of Medicare Advantage.