How Do Medicare Advantage Plans Compare to Traditional Medicare?

Medicare Advantage and traditional Medicare beneficiaries reported similar satisfaction rates, but access to care, affordability, and healthcare utilization differed among the two populations, according to research from the Kaiser Family Foundation (KFF).

Researchers reviewed 62 studies published between January 1, 2016, and May 1, 2022 that compared Medicare Advantage and traditional Medicare on measures of beneficiary experience, affordability, utilization, and quality.

Sixteen studies focused on beneficiary experience, including satisfaction with care, access to care, care coordination, prescription drugs, and switching between Medicare and Medicare Advantage.

Care satisfaction was generally similar for Medicare Advantage and traditional Medicare beneficiaries.

One study found no differences in satisfaction with doctors’ concerns for health, information about medical conditions, care by specialists, information obtained by phone, and quality of medical care.

Three other studies found similar satisfaction rates among beneficiaries with diabetes, Alzheimer’s disease, and mental illness. In one study, experience with care at the end of life was rated higher for traditional Medicare than Medicare Advantage.

Medicare Advantage beneficiaries were more likely to have a usual source of care than those enrolled in traditional Medicare, the review found. The share of Medicare Advantage beneficiaries who reported having a usual source of care was higher by 0.9 to 4.0 percentage points. Medicare Advantage members were also more likely to report a primary care clinician as their regular source of care, according to one study.

Care coordination was similar for beneficiaries in Medicare Advantage and traditional Medicare, two studies found. However, one study revealed that more Medicare Advantage members reported receiving specific care management practices.

Generally, individuals enrolled in Medicare Advantage reported better experiences getting prescription drugs than those in traditional Medicare. One exception was a study that found that traditional Medicare beneficiaries with cancer were more likely to report excellent experience obtaining prescription drugs than Medicare Advantage members with cancer.

Dual eligible beneficiaries and beneficiaries of color had high rates of switching between traditional Medicare and Medicare Advantage, the review found. Rural beneficiaries and those who experienced an onset of a functional impairment were more likely to switch from Medicare Advantage to traditional Medicare.

Seven studies included in the review focused on the affordability of the two programs.

Cost-related problems were less common among traditional Medicare beneficiaries compared to Medicare Advantage members. This was mainly driven by traditional Medicare beneficiaries with supplemental insurance experiencing fewer problems.

In particular, traditional Medicare beneficiaries who were Black, under age 65 with disabilities, or in poor health reported fewer cost-related problems than their Medicare Advantage counterparts, according to one study.

In contrast, Medicare Advantage members had higher rates of preventive care utilization. For example, Medicare Advantage beneficiaries were more likely to report having an annual wellness visit or routine checkup than traditional Medicare beneficiaries. Additionally, Medicare Advantage beneficiaries had higher vaccination rates and higher rates of colorectal cancer, breast cancer, and blood pressure screenings.

The number of hospital stays was lower in Medicare Advantage plans for individuals with Alzheimer’s disease and related dementias (ADRD) and those with diabetes. However, two studies found no differences in hospital utilization between the two programs.

Medicare Advantage beneficiaries had lower hospital readmission rates within skilled nursing facilities, home healthcare, and hospitals in general. Two studies found that Black beneficiaries were more likely to be readmitted to the hospital than White beneficiaries in Medicare Advantage and traditional Medicare.

Medicare Advantage is becoming an increasingly popular option for seniors and individuals with disabilities.

Medicare Advantage enrollment has grown by 2.2 million beneficiaries between 2021 and 2022, according to a separate KFF analysis. In addition, almost half of all eligible Medicare beneficiaries are enrolled in Medicare Advantage plans.

JD Power’s 2022 Medicare Advantage Study also found that member satisfaction increased by 3 points this year.