UMEM Educational Pearls

Title: Medicare Advantage - Why it matters

Category: Administration

Keywords: Medicare advantage, insurance, payor (PubMed Search)

Posted: 1/12/2024 by Steve Schenkel, MPP, MD (Updated: 1/30/2024)
Click here to contact Steve Schenkel, MPP, MD

Approximately half of all Medicare beneficiaries are now enrolled in Medicare Advantage plans. Why does this matter?

  • Traditional insurers (for example, United & Blue Cross) run Medicare Advantage (MA) plans. The federal government pays the insurers. This is different from Traditional Medicare which the Federal Government both funds and runs.
  • MA plans may include prescription drug, vision, and dental care. They also often include out-of-pocket caps.
  • MA plans may limit flexibility in provider choice with in-network and out-of-network provisions.
  • So far, MA costs the federal government more than traditional Medicare.

Intrigued? Learn more at https://www.nejm.org/doi/full/10.1056/NEJMhpr2302315 or https://www.kff.org/medicare/issue-brief/medicare-advantage-2024-spotlight-first-look/.