Medicare Advantage: Lower Premiums, Limited Choices

Medicare Advantage, also called Part C, is a private insurance alternative to Original Medicare. While marketed as cost-saving, Medicare Advantage plans come with tradeoffs that beneficiaries should weigh carefully.

When individuals enroll in Medicare Advantage, they give up their Original Medicare Part A (hospital insurance) and Part B (medical insurance). While many Advantage plans boast zero or low premiums, added benefits, and set out-of-pocket maximums, the reality is more complex. Plans often restrict members to narrow physician networks—one 2017 study found that, on average, these plans included only half of U.S. physicians.

Approval hurdles are another drawback. Medicare Advantage members frequently must seek prior authorization for treatments, hospital stays, prescription drugs, and even diagnostic tests. Without approval, care may be denied. This restriction has raised concerns about access, particularly for those managing chronic illnesses.

Financially, Medicare Advantage has not proven cheaper overall. In 2023, Medicare paid $454 billion to private insurers for Advantage plans—54% of total Medicare spending, up from 27% in 2015. Studies indicate that Medicare Advantage costs the government 6% more per enrollee compared to Original Medicare.

For Pawnee County residents, these details matter. With a smaller healthcare network locally available, many Advantage plan enrollees may find themselves forced to seek care outside the area or travel long distances for specialists. Delays caused by prior authorizations could further complicate treatment for chronic conditions common among older Kansans. While Medicare Advantage may appeal with its upfront savings, residents should consider whether the convenience of bundled coverage outweighs the risks of limited access in a rural community.