Medicare Your Coverage Options

Most people choose traditional Medicare over Medicare Advantage

Written by Diane Archer

More than twice as many people enrolling in Medicare choose traditional Medicare over a Medicare Advantage plan. A new report from the Kaiser Family Foundation suggests that most older adults and people with disabilities want open access to doctors and hospitals and fewer administrative hassles. Only traditional Medicare offers these benefits.

Kaiser found that 71 percent of people enrolling in Medicare for the first time chose traditional Medicare, as compared with 29 percent who chose Medicare Advantage. People choosing traditional Medicare appear willing to spend more on their coverage upfront and want to avoid getting a referral or a prior authorization before receiving specialty care.

Given how little we know about different Medicare Advantage plans, it’s not surprising that most people are choosing traditional Medicare over Medicare Advantage. Traditional Medicare puts them and their doctors in charge of their health care. Here are four things to think about when make a choice between traditional Medicare and Medicare Advantage.

With Medicare Advantage plans, there’s compelling evidence that for-profit insurers wrongly delay and deny care a significant amount of the time. And, we have reason to believe they limit care, covering fewer physical therapy and home care visits. They have unpredictable out-of-pocket costs that can be as high as $6,700 a year for in-network care alone.

Moreover, we have virtually no good information identifying the Medicare Advantage plans that deliver good coverage. Medicare’s five-star ratings system does not provide good information, according to MedPAC, an independent federal body advising Congress on health care financing and delivery. Since Medicare Advantage plans restrict your access to health care providers, may override your treating physician’s opinion about the care you need and do not disclose typical out-of-pocket costs for people with complex conditions, enrollment is a gamble.

The rate of initial enrollment in Medicare Advantage plans has increased by about 1 percentage point a year for the last several years, from 23 percent in 2011 to 29 percent in 2016. It appears that most older adults and people with disabilities are willing and able to spend more upfront for better coverage.

That said, Medicare enrollment choices differ dramatically in different parts of the country. People with Medicare in Oregon and Minnesota were more likely to enroll in Medicare Advantage when they first signed up for Medicare than people in other parts of the country. Four in ten of them chose Medicare Advantage over traditional Medicare.

People in Delaware, Maryland, Nebraska, New Hampshire, and Vermont, as well as Washington DC, tend to prefer traditional Medicare. Fewer than 11 percent of them enrolled in Medicare Advantage plans when they first enrolled in Medicare.

People with disabilities were far more likely to enroll in traditional Medicare than people who enrolled in Medicare at 65 or older. In 2016, just 22 percent of people with disabilities enrolled in a Medicare Advantage plan as compared with 31 percent of people 65 or older.

People with Medicaid and Medicare, dual-eligibles, also were far less likely to enroll in Medicare Advantage than people not eligible for Medicaid. In 2016, 18 percent of dual-eligibles signed up for Medicare Advantage as compared to 31 percent of people solely eligible for Medicare.

Here’s more from Just Care:


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