:max_bytes(150000):strip_icc()/GettyImages-2027653518-349673338c1b4ffcbbfa7b29f80fba4f.jpg "Medicare Advantage Could Save You Money—If You’re Willing to Sacrifice This")
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KEY TAKEAWAYS
- Enrollment in Medicare Advantage plans, which are offered by private insurers, has increased over the years as many plans provide lower premiums and more benefits.
- However, the tools that make the Advantage health insurance plans cheaper also restrict the number of physicians available to enrollees.
Medicare Advantage health insurance plans can offer more benefits and monthly premiums as low as $0—but they come with some caveats and restrictions.
Enrollment in Medicare Advantage, an alternative to traditional Medicare distributed by private insurers, has increased over time, from 8 million in 2007 to 33 million in 2024, according to a report from nonpartisan health care research organization KFF. This shift is mainly due to the fact that Advantage plans typically have cheaper premiums and offer more types of benefits.
Yet, a recent report from KFF showed that the average Advantage enrollee’s plan in 2022 only covered 48% of the physicians that are available for traditional Medicare enrollees.
Advantage plans can typically offer coverage for more health services than traditional Medicare plans, such as routine vision, hearing, and dental care. Private insurers distributing Advantage plans can lower prices by utilizing provider networks, a list of physicians and hospitals covered by the plan, and implementing prior authorization.
The same tools that Advantage insurers use to provide extra benefits and lower costs, however, also severely restrict the number of in-network health providers their enrollees can visit. And unlike Advantage plans, traditional Medicare enrollees can go to any U.S. doctor or hospital that accepts Medicare.
Why This Matters
It’s open enrollment season, and as Medicare costs rise in 2026, many beneficiaries are looking for better coverage and more affordable plans. While advantage plans often provide lower premiums and additional benefits, they typically come with limited access to physicians compared to traditional Medicare.
Access to physicians also varies by county. According to KFF calculations, in the top 30 counties with the largest MA enrollee population, the share of physicians in-network for MA enrollees varied from 18% to 58%.
Accessibility even varies among plans. A third of Medicare beneficiaries were in a county where one Advantage plan in their area covered a quarter of the doctors available to traditional Medicare, versus another plan in the same area that covered two-thirds of physicians.
Yet, few tools exist to help enrollees compare Advantage plans and which physicians are covered under them. Of the existing tools, the directories are only correct about half of the time about which physicians are in-network, the Center for Medicare and Medicaid found.
