Medicare vs. Medicare Advantage: What You Need to Know Before Medicare Open Enrollment

November 22, 2022

With Medicare Open Enrollment set to begin on October 15, we want to ensure Medicare beneficiaries are informed about their options so they can receive the best coverage for their needs. To help make this decision easier, My Patient Rights has pulled highlights from a Kaiser Family Foundation analysis of 62 studies comparing Medicare’s traditional health coverage with their private plan known as Medicare Advantage. The plans were evaluated on beneficiary experience, affordability, utilization, and quality. While both Medicare and Medicare Advantage reported similar rates of satisfaction in most of these measures, some areas showed significant differences, including:

Traditional Medicare:

• Fewer Medicare beneficiaries experienced cost-related problems than Medicare Advantage enrollees, as supplemental coverage helped lower rates.
• When it came to receiving care in the highest-rated hospitals for cancer care or nursing facilities and home health agencies, traditional Medicare outperformed Medicare Advantage.

Medicare Advantage:

• Medicare Advantage enrollees were more likely to have a usual source of care as well as to receive preventative care, such as screenings, wellness visits and routine checkups, and vaccines.
• Overall, enrollees of Medicare Advantage had a better experience getting needed prescription drugs than traditional Medicare beneficiaries.
• Utilization of home health services and post-acute skilled nursing or inpatient rehabilitation facility care was lower among Medicare Advantage enrollees, but it was inconclusive whether lower utilization was associated with better or worse outcomes.

Outside of those mentioned above, Kaiser Family Foundation found mixed or very little differences between the two plans in the following areas:

• Wait times
• Trouble finding a general doctor
• Being told new patients weren’t being accepted.
• Being told their health insurance wasn’t accepted
• Length of stay in hospitals or stay for common medical admissions

In addition, findings of healthcare services such as prescription drugs and hospital care varied, possibly due to the difference in data and methodology of the studies reviewed.

We encourage you to read the full report to further decide what option is best for you and your health. The Medicare enrollment period will run through December 7, 2022, and coverage will begin on January 1, 2023.