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Seniors Miss Out on Services With Medicare Advantage

Medically reviewed by Carmen Pope, BPharm. Last updated on Jan 21, 2025.

By Dennis Thompson HealthDay Reporter

TUESDAY, Jan. 21, 2025 -- Medicare Advantage isn’t that great an advantage for seniors compared with traditional Medicare, researchers say.

The privatized form of Medicare offers more supplemental benefits than traditional Medicare, including dental, vision and hearing benefits.

But many seniors aren’t using those additional benefits, and their out-of-pocket costs are about the same as with regular Medicare, researchers report in a study published recently in JAMA Network Open.

For example, just a little more than half of seniors (54%) with Medicare Advantage are aware of having either dental or vision coverage, even though nearly all plans offer those benefits, results show.

“Supplemental benefits are a major draw to Medicare Advantage, but our findings show that people enrolled in Medicare Advantage have no better access to extra services than people in traditional Medicare, and that much of the cost comes out of their own pockets,” senior researcher Dr. Lisa Simon, an assistant professor of general and internal medicine at Brigham and Women’s Hospital in Boston, said in a news release.

“Older adults and people with disabilities deserve better from Medicare,” Simon added.

About 51% of Medicare beneficiaries enrolled in Medicare Advantage in 2023, researchers said in background notes.

The federal government pays Medicare Advantage plans about 22% more than the cost of covering similar beneficiaries under traditional Medicare, which amounted to about $83 billion in 2024.

For the study, researchers analyzed data from 2017 to 2021 gathered by an annual Centers for Medicare and Medicaid Services beneficiary survey, as well as an annual federal review of the cost of health care in the U.S.

Seniors pay about the same or slightly less out-of-pocket for services under Medicare Advantage compared to traditional Medicare, researchers found.

For example, Medicare Advantage beneficiaries paid nearly $206 for eyeglasses, about 9% less than the $226 paid under traditional Medicare.

Similarly, seniors paid nearly $227 for dental visits under Medicare Advantage, about 9% less than the $250 paid by people in traditional Medicare.

Seniors in either plan paid about the same for optometry visits and durable medical equipment like hearing aids, results show.

Nationwide, Medicare Advantage plans spent about $3.9 billion on vision, dental services and durable medical equipment, while enrollees spent $9.2 billion out-of-pocket for those services and supplemental insurance covered $2.8 billion.

Overall, private Medicare Advantage plans received $37.2 billion more a year in federal funding than taxpayers would have spent if the beneficiaries had enrolled in traditional Medicare, researchers concluded.

“Medicare Advantage plans receive more money per beneficiary than traditional Medicare plans, but our findings add to the evidence that this increased cost is not justified,” lead researcher Dr. Christopher Cai, a resident with Brigham and Women’s Hospital, said in a news release.

Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions.

© 2025 HealthDay. All rights reserved.

Posted January 2025

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