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Private Medicare plans now cover more than half of all Medicare patients

Article

More than 30 million Americans are now covered via private plans

The majority of people insured by Medicare have their coverage provided by private payers via the Medicare Advantage program, according to CMS data. As of January, 30.19 million of the 59.82 million people with both Medicare Part A and Part B were enrolled in a private plan.

Medicare: ©Vitalii Vodolazskyi - stock.adobe.com

Medicare: ©Vitalii Vodolazskyi - stock.adobe.com

Medicare Advantage is a private plan alternative to traditional government-administered Medicare that covers most benefits at little or no additional cost. Insurance companies contract with Medicare and are paid by the government for providing these services.

The growth in private plans has been dramatic. In 2007, 19% of eligible Medicare beneficiaries were enrolled in a private plan, while more than half are enrolled in private plans today. Luring patients to these private plans are extra benefits, such as vision, hearing, and dental services, plus the potential for lower out-of-pocket spending, especially when compared to traditional Medicare without supplemental coverage, according to the Kaiser Family Foundation. The plans are also often simpler, with enrollees not needing a separate prescription drug plan or supplemental coverage.

However, Medicare Advantage plans often use prior authorizations and require in-network doctors be seen, and also require a referral to specialists in order to limit access to care and manage costs. The prior authorization requirements have come under scrutiny for being too restrictive and preventing people from receiving care that they are eligible for.

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Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health