Since the 1970s, Medicare beneficiaries have had the option to receive their Medicare benefits through private health plans, mainly Health Maintenance Organizations (HMOs), as an alternative to the federally administered traditional Medicare program. The Balanced Budget Act (BBA) of 1997 named Medicare’s managed care program “Medicare+Choice” and the Medicare Modernization Act (MMA) of 2003 renamed it “Medicare Advantage.” In 2017, the majority of the 57 million people on Medicare are covered by traditional Medicare, with one-third (33%) enrolled in a Medicare Advantage plan. Since 2004, the number of beneficiaries enrolled in private plans has more than tripled from 5.3 million (13%) to 19.0 million in 2017 (33%).
Featured Medicare Advantage Resources
This fact sheet includes the latest information and data about the Medicare Advantage program, including enrollment, plan information, spending and financing for the program, and payment and program changes made by the Affordable Care Act as well as other laws.
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This report takes an in-depth look at Medicare Advantage plans’ physician networks. The analysis draws upon data from 391 Medicare Advantage plans serving beneficiaries in 20 diverse counties in 2015. The report examines the size and composition of plans’ physician networks, the variation across counties, the inclusion of physicians by specialty, and the relationship between network size and other plan features, such as premiums and quality star ratings.
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This September 2014 Visualizing Health Policy Infographic examines the role of private plans, such as HMOs and PPOs, in Medicare. These Medicare Advantage plans offer an alternative to traditional Medicare and provide all benefits covered under Medicare Parts A and B, and often Part D. The infographic includes data on Medicare Advantage penetration across the country. It shows the concentration of enrollment among a small number of firms and affiliates, and displays the extent to which Medicare pays more for Medicare Advantage enrollees than for beneficiaries in fee for service Medicare, on average, and that the payment differential is declining
This Visualizing Health Policy infographic provides a snapshot of the role of Medicare Advantage plans, an alternative to traditional Medicare, including information about the proportion of Medicare beneficiaries who are enrolled in Medicare Advantage plans, geographic differences in Medicare Advantage penetration, the trend of increasing enrollment in Medicare Advantage plans,…
Report & Briefing Examine How Seniors Choose Among Their Medicare Plan Options Seniors appreciate having a wide range of Medicare private plan choices available to them but often feel unqualified to choose among them, a new Kaiser Family Foundation report concludes. Based on discussions with seniors in four cities around…
This report summarizes first-hand accounts of seniors’ Medicare private plan decision making strategies, based on focus groups conducted in four cities. Seniors found the initial plan selection process overwhelming due to the volume of information they received and their inability to organize it. Few used the government’s online comparison tool, and those that did cite several shortcomings. Many relied on advice from sources they trust, including insurance agents, plan representatives, friends, family members, doctor’s offices and pharmacists. After they enroll in a plan, many seniors did not revisit their initial decision or review plan options without the strong provocation of a substantial increase in cost, change in coverage, or shift in personal health care needs. Moreover, they feared that a change in plans may disrupt their care, or lead to an unforeseen increase in out-of-pocket costs, and require them to learn new rules and requirements. They are doubtful they would end up in a plan that is appreciatively different or better for them. Overall, seniors preferred to have numerous choices in plans but would like personalized help and advice from experts to ease the process.
In the latest post in the Policy Insights series, Tricia Neuman and Gretchen Jacobson examine the surprising growth in Medicare Advantage enrollment following payment reductions included in the Affordable Care Act. Previous columns in the Policy Insights series are also available on kff.org.
This Policy Insight explores possible explanations for the continued rise in Medicare Advantage enrollment between 2010 and 2013 in spite of a projected decrease following payment changes in the Affordable Care Act (ACA).
This Data Spotlight provides an overview of Medicare Advantage enrollment patterns in March 2014, and examines variations by plan type, state, and firm. It also analyzes trends in premiums paid by beneficiaries enrolled in Medicare Advantage plans and describes the changes in limits on out-of-pocket expenses and prescription drug coverage in the Part D “donut hole” provided by the plans in 2014.
A new brief from the Kaiser Family Foundation documents the continuing climb in Medicare Advantage plan enrollment, even at a time when payments to such plans are being reduced under the Affordable Care Act. Despite spending reductions enacted in the ACA to reduce historical overpayments to Medicare Advantage plans, from…
This data spotlight report examines trends in the Medicare Advantage marketplace, including the choices available to Medicare beneficiaries in 2014, premium levels and other plan features. Medicare beneficiaries, on average, will have 18 private Medicare Advantage plans available to them in 2014, reflecting both new plans entering the market and old plans exiting it. If Medicare Advantage enrollees remain in their current plans, average monthly premiums will rise by almost $5 per month, or 14 percent, to $39 per month. The analysis also examines some benefits provided by Medicare Advantage plans including drug coverage and caps on out-of-pocket spending, and finds that average out-of-pocket limits across all plans will climb 11 percent to $4,797 in 2014. Additionally, this analysis examines changes in the types of plans available (HMOs, PPOs, etc.), including special needs plans in 2014.