Medicare’s open enrollment period is here, meaning millions of older Americans and people with disabilities can compare their plans and make changes to their health care coverage. If recent trends hold true, more than half of all enrollees will choose a Medicare Advantage (MA) plan – the private alternative to traditional Medicare.
What many enrollees do not understand is that their “choice” was actually made for them.
The U.S. government now pays MA plans at least 22% more per enrollee than it would cost to cover the same person under traditional Medicare. But more money doesn’t mean enrollees get better care. MA plans perform no better and are in some ways worse than traditional Medicare. The money also does not appear to give enrollees meaningful control over their coverage decisions. Instead, MA bombards participants with a complicated set of options that are so overwhelming that almost 70% of people don’t even try to compare what’s available to them.
Most alarming, despite massive federal subsidies, MA plans are increasingly erecting barriers to patient care, including burdensome prior authorization requirements that can delay necessary procedures, and narrow networks that can exclude higher-quality providers—while they often fail to save. registered money for care.
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More: Considering Medicare Advantage during open enrollment? Beware of this trap.
Nevertheless, the MA program continues to grow because for many enrollees, traditional Medicare – with its 20% coinsurance and lack of out-of-pocket spending limits – is not financially feasible. For an older American living on a low or fixed income, who must choose between a zero-dollar MA plan that claims to cover all of life’s necessities, or paying more than $200 per month for a supplemental Medigap policy to to protect against financial catastrophe – plus additional premiums for a supplemental drug plan and any dental, vision and hearing services – is actually no choice at all.
In recent years, the Biden administration has sought to address some of MA’s limitations by bringing more consumer protections, transparency and accountability to the program. While these efforts must continue, we also need action from Congress to improve the Medicare program for all so that the choice between MA and traditional Medicare makes sense.
If Congress were instead to double down on further privatization of Medicare, the results could be disastrous. For example, the far-right authoritarian playbook known as Project 2025 calls for making MA the “default” for all enrollees. This would effectively push even more people into the program. If, as a result, only 50% more people were to enroll in MA, the Center for American Progress estimates that this would contribute to $2 trillion in waste over the next decade, while providing no meaningful health benefit to enrollees.
On the other hand, Congress could level the playing field by giving Medicare enrollees a real choice between MA and traditional Medicare. To put the full extent of government investment in MA into perspective, the Center for American Progress estimates that the program will be overfunded by as much as $127 billion by 2024 alone, with any “savings” that many MA plans will benefit shareholders.
That’s more than enough money to expand traditional Medicare coverage to include dental, vision and hearing benefits and implement an annual cap on out-of-pocket spending — reforms that would help all Medicare beneficiaries. The money could also be used to fund home health care providers, a critical coverage gap for Medicare.
As Medicare beneficiaries navigate potential changes to their coverage during this open enrollment period, the reality is that far too many enrollees will not have a meaningful choice in front of them — but lawmakers will.
Andrea Ducas is vice president of health policy at the Center for American Progress. David Lipschutz, JD, is co-director of law and policy at the Center for Medicare Advocacy.
More: Medicare Open Enrollment: Keep these three things in mind when choosing your 2025 plan
Also read: One reason I’m wary of Medicare Advantage? I am a capitalist.
