For the first time since its inception, insurers predict that Medicare Advantage enrollment will drop in 2026 and that most people with Medicare will be enrolled in traditional Medicare, which the federal government directly administers. Unlike corporatized Medicare Advantage, traditional Medicare (TM) guarantees you the choice of care from the best doctors and hospitals. And, TM provides easy access to reliable care.
In stark contrast, there’s nothing reliable about Medicare Advantage. Choosing a Medicare Advantage (MA) plan–an HMO or PPO run by a corporate health insurer– means gambling with your life. Medicare Advantage plans can keep you from seeing the best doctors and hospitals and wrongly delay and deny care that Traditional Medicare covers.
Insurers are ending many of their Medicare Advantage plans because they are not profitable. They are also cutting additional benefits. People with Medicare will still have far too many choices of Medicare Advantage plans. Each plan is different, with different provider networks, prior authorization rules and costs, but the information is not available for people to avoid the Medicare Advantage plans that wrongly delay and deny care.
Insurers are saying that their costs are rising at the same time that the government has cut payments a little. To be clear, the data show that the government is still overpaying the insurers offering Medicare Advantage more than $80 billion a year. But, the insurers recognize that they can maximize profits if they pull out of certain markets and pare back on certain extra benefits like dental and vision care.
Elevance ended dental, vision and hearing benefits in many Medicare Advantage plans.
Insurers want to avoid the enrollees who are not profitable. Offering fewer PPOs, which cover care outside of the insurers’ network, is one way for them to boost their profits. Sicker people won’t sign up. Some insurers also stopped paying commissions to brokers who enrolled people in PPOs, another way to keep people out of PPOs and boost their profits.
Insurers have also raised out-of-pocket maximums and deductibles, forcing people with costly conditions to spend more before their care is fully covered.
Here’s more from Just Care:
- Four things to know if your income is low and you have Medicare
- Programs that lower your costs if you have Medicare
- Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan
- Medicare Advantage networks can be narrow and harmful
- If you want easy health care access and good quality care, you probably want traditional Medicare
