FREE NEWSLETTER
Predictions are the trend to enroll in Medicare Advantage plans will slow and MA plans will be forced to trim benefits. A recent article on MarketWatch provides more analysis.
Many seniors still like MA plans for their extra benefits and generally lower premium costs, but they don’t like limited networks, required referrals, deductibles and co-pays in some cases.
But that is not the problem.
According to the (10/4/25) article, “The market (for insurers) remains lucrative as the government pays 22% more per Medicare Advantage enrollee, or about $83 billion a year more, than if that person had been enrolled in traditional Medicare, according to the Medicare Payment Advisory Commission, the independent federal agency that advises the U.S. Congress on issues affecting the Medicare program.”
MA plans were supposed to save Medicare money. Why the reverse was allowed to happen is questionable. Probably poor management, but no doubt politics as well.
In any case, sooner or later MA beneficiaries will pay more, receive fewer benefits or in some cases their plan will disappear.
Received my Kaiser MA “Annual Notice Of Change For 2026” the other day. The Monthly Plan Premium is going up by 41%, many of the copays are going up by 50% and the benefits have been reduced. This is for the Silver HMO plan.
Kaiser is very efficient and I’m sticking with them.
Unfortunately, regular Medicare is increasingly going to be subject to all the pre-approval nonsense of MA plans. Medicare is pushing Accountable Care Organizations which seek to reduce the cost of Medicare to the government. See:
https://www.cms.gov/priorities/innovation/key-concepts/accountable-care-and-accountable-care-organizations
The only advantage which regular Medicare users have over MA plans is that insurance companies are not involved in ACO operations as these are directly between providers and Medicare.
No, not that advantage, regular Medicare does not use networks, you are free to go anywhere in the country and you do not need any referrals.
Pre-approval is not nonsense. It is a valid cost containment measure and if done right a benefit to patients. There is some concern that Medicare if providing financial incentives to review organization.
There are easy pickings for savings if Medicare paid MA plans no more than the cost of basic Medicare.
Not all health care is necessary (about 25% is not according to doctor’s estimates) or effective.
I often wonder what people would think of cost management procedures if they were actually paying the bill as opposed to a third party – government or insurers or most often their employers.
Every system in the world employs some technique to control costs.
I will be looking for any changes to my mom’s MA plan. She is all about the $0 monthly payment besides the Medicare Part B amount. She also gets $$ quarterly for HSA type stuff, but the amount has gone down every year. She has to pay deductibles and copays. I am not sure she saves any money unless she doesn’t go to the dr much that year. I am not the financial person for her. Chris