Medicare Advantage can save you money, if you’re willing to sacrifice that

Medicare Advantage health insurance plans can offer more benefits and monthly premiums as low as $0, but they come with some caveats and limitations.

Enrollment in Medicare Advantage, an alternative to traditional Medicare distributed by private insurers, has risen over time, from 8 million in 2007 to 33 million in 2024, according to a report by the nonpartisan health care research organization KFF. This shift is mainly due to the fact that Advantage plans typically have cheaper premiums and offer more types of benefits.

However, a recent report from KFF showed that the plan of the average Advantage enrollee in 2022 only covers 48% of the doctors available to traditional Medicare enrollees.

Advantage plans can typically provide coverage for more health services than traditional Medicare plans, such as routine vision, hearing, and dental care. Private insurers that distribute Advantage plans can lower prices by taking advantage of provider networks, the list of doctors and hospitals covered by the plan, and implementing prior authorization.

However, the same tools that Advantage insurers use to provide additional benefits and lower costs also severely restrict the number of in-network health providers enrollees can visit. Unlike Advantage plans, traditional Medicare enrollees can go to any U.S. doctor or hospital that accepts Medicare.

Access to doctors also varies by province. According to KFF’s calculations, in the top 30 counties with the highest number of MA enrollees, the in-network physician share of MA enrollees ranged from 18% to 58%.

Accessibility even varies between plans. One-third of Medicare beneficiaries were located in a county where one Advantage plan in their area covered a quarter of the doctors available for traditional Medicare, versus another plan in the same area that covered two-thirds of the doctors.

However, there are few tools to help enrollees compare Advantage plans and the doctors covered by them. Of the existing tools, the evidence is correct only about half the time when doctors are in-network, the Center for Medicare and Medicaid found.