Medicare Advantage Checkup

The emerging role of Medicare Advantage, the private-plan alternative to traditional Medicare, is gradually changing the Medicare program in ways that have important implications for beneficiaries, providers, and spending. Fueled by policy changes adopted by both Democrats and Republicans, enrollment in Medicare Advantage plans has more than tripled since 2005, from approximately 6 million to 20 million beneficiaries. Between 2018 and 2028, Medicare Advantage enrollment is projected to rise from 34% to 42% of the Medicare population (Fig. 1). At the same time, federal spending on behalf of Medicare Advantage enrollees is projected to grow from approximately $200 billion to more than $580 billion (not including additional Medicare spending associated with coverage of prescription drugs under Medicare Part D).1 In this article, we begin with a brief comparison of Medicare Advantage relative to traditional Medicare. We then examine the extent to which the Medicare Advantage program is achieving goals with respect to benefits and out-of-pocket costs, plan choice, federal spending, and quality.2,3 We highlight areas in which more evidence is needed to better understand the implications of the shift from traditional Medicare toward private-plan enrollment, and we identify ongoing challenges. © 2018 Massachusetts Medical Society.