The growth of Medicare Advantage (MA) plans over the past 15 years- reaching 54% of Medicare beneficiaries by 2024, or roughly 33 million enrollees, is generally attributed to a combination of policy changes, market dynamics, and genuine appeal to beneficiaries. I, for one, have evolved in my thinking regarding these alternatives to traditional Medicare, initially preferring traditional Medicare, but now actively encouraging clients to explore the MA option, particularly to facilitate aging in place planning. For example, see the following articles:
A recent article, however, suggests that MA plans are popular because they are compelled or coerced, and the rising number of subscribers doesn't reflect a real "preference." "Medicare Advantage is covering more and more Americans − some because they don’t get to choose," published on The Conversation on April 3, 2025, by Grace McCormack and Victoria Shier, presents a critical perspective on the rapid expansion of Medicare Advantage (MA) plans in the United States. While it raises valid concerns about privatization trends, cost to taxpayers, and limited choice for some beneficiaries, the piece has several shortcomings in its analysis, including a lack of consideration and analysis of counterarguments, an overemphasis on negative framing, and insufficient exploration of the broader context driving MA’s growth. What follows are my thoughts.
The article’s central thesis is that MA’s growth is driven by a lack of choice, particularly for retirees whose employers or state governments limit subsidies to MA plans, effectively "forcing" them into privatization. While this is a legitimate point, supported by the claim that 13 states and over half of large private employers offering MA do not subsidize traditional Medicare supplements, I think it oversimplifies the decision-making process for beneficiaries. The authors imply a coercive dynamic, but fail to adequately explore why employers and states have shifted toward MA in the first place.
For instance, they do not discuss the financial incentives for employers, such as lower administrative costs or the ability to offload retiree healthcare liabilities onto private insurers, which MA plans often market as a benefit. Nor do they consider that some beneficiaries might prefer MA’s bundled coverage (e.g., vision, dental, and hearing benefits) over traditional Medicare, even if choice is constrained.
Moreover, the article does not quantify how many individuals are truly "forced" into MA versus those who opt in voluntarily after weighing options. The statistic that 54% of Medicare beneficiaries are enrolled in MA (up from 8 million to 33 million between 2007 and 2024) is striking, but it conflates voluntary and involuntary enrollment without breaking down the proportions. This lack of granularity weakens the claim that lack of choice is a primary driver, as it could equally reflect MA’s appeal to a broad population.
The article highlights that switching from MA back to traditional Medicare is "often difficult," citing the loss of guaranteed-issue rights for Medigap plans after the initial enrollment period. This is technically accurate- outside of four states (Connecticut, Maine, Massachusetts, and New York), Medigap insurers can deny coverage or charge higher premiums based on preexisting conditions if beneficiaries leave MA after their first year. The authors do not explore the extent to which this locks people in practice, however, ignoring the initial opportunity to abandon the MA plan, and/or the opportunity a younger retiring spouse has to consider the first retiring spouse's choice and experience. For example, they do not provide data on how many MA enrollees attempt to switch and are denied Medigap, nor do they discuss the role of Special Enrollment Periods or protections for those whose MA plans are discontinued (e.g., the 63-day guaranteed-issue window mentioned in related sources).
My personal experience in planning suggests that the most of these seemingly compelled choices involve the second retiring spouse, often the wife, who has had the benefit of experience with traditional Medicare. I find that they often welcome the opportunity abandon Medicare. I wondered how accurate my experience might be, and was surprised to learn that women make up roughly 75% of public school teachers and 80% of nurses, both significant state employee groups in many states. Women have historically been well-represented in public sector jobs, particularly in fields like education and health services, which dominate state budgets. My experience might be an accurate reflection of what other planners experience.
The article's framing suggests the existence of a "trap" without acknowledging that many beneficiaries may not want to switch, either because they are satisfied with MA or because traditional Medicare’s uncapped out-of-pocket costs (absent Medigap) are less appealing. The article could have strengthened its argument by delving into beneficiary satisfaction rates or real-world examples of switching difficulties, rather than leaving the claim as a broad assertion, but I assume the former statistics, particularly, don't support the argument.
The authors draw a parallel between MA’s growth and the privatization of Medicaid, noting that 74% of Medicaid beneficiaries are in private plans, often without choice. This comparison is intriguing but underdeveloped. Medicare and Medicaid serve different populations with distinct needs: Medicare’s is older, often healthier enrollees versus Medicaid’s low-income, higher-needs population, and the dynamics of privatization differ significantly. The article does not explain why MA’s privatization mirrors Medicaid’s beyond the lack-of-choice angle, nor does it address the historical policy decisions (e.g., the 2003 Medicare Modernization Act) that incentivized MA’s expansion through higher payments and marketing flexibility.
Furthermore, the authors gloss over the political and economic forces behind MA’s rise, such as lobbying by insurance companies or bipartisan support for market-based solutions in healthcare. Without this context, the critique feels surface-level, attributing MA’s dominance to employer decisions and beneficiary inertia rather than a deliberate systemic shift.
The article relies heavily on enrollment trends (e.g., the quadrupling of MA enrollment since the mid-2000s) and broad statements about employer practices, but it lacks specific, compelling evidence to support its more critical claims. For instance, the assertion that "more patients can be denied doctor-ordered care" in MA plans alludes to prior authorization requirements but offers no statistics on denial rates or their impact on health outcomes compared to traditional Medicare.
The article focuses almost exclusively on systemic downsides—cost, coercion, and care denials—while giving short shrift to why MA might appeal to beneficiaries beyond "lower premiums and co-pays and the promise of extra benefits." Surveys, such as those from the Commonwealth Fund, show that MA enrollees often report high satisfaction with care coordination and supplemental benefits like dental and vision coverage, which traditional Medicare lacks. The authors mention these attractions briefly but dismiss them as bait without exploring whether they deliver value for some enrollees. This omission creates a lopsided critique that paints MA as a net negative, ignoring the possibility that its growth reflects genuine demand rather than just manipulation or lack of choice.
The authors assert that MA "burdens taxpayers" by costing more per enrollee than traditional Medicare, a point often echoed in critiques of privatization. They cite the growth in enrollment as increasing this burden but provide no specific figures in the article to substantiate the scale of the overpayment (though related literature, such as from The Conversation’s other pieces, suggests an additional $83 billion annually). While this is a valid concern, studies like those from MedPAC have shown MA plans receive higher risk-adjusted payments due to upcoding of diagnoses—the article does not engage with counterarguments that MA plans might reduce certain costs, such as through preventive care or reduced hospital readmissions, which some research suggests they achieve more effectively than traditional Medicare.
Additionally, the piece does not compare the total cost of traditional Medicare (including supplemental Medigap plans and Part D drug coverage, which beneficiaries often purchase separately) to MA’s all-in-one model. For many beneficiaries, the out-of-pocket savings from MA’s lower premiums and cost-sharing could offset taxpayer overpayments in practical terms, a trade-off the article ignores. By framing MA solely as a taxpayer burden, presents a one-sided narrative that overlooks potential efficiencies or benefits that might justify its higher upfront costs.
Finally, the article raises concerns about MA’s dominance but stops short of proposing solutions or grappling with the feasibility of reversing the trend. If MA’s growth is problematic, what alternatives exist? Should policymakers cap enrollment, reform payment structures, or expand traditional Medicare’s benefits to compete? The authors call for understanding "why Medicare Advantage has become so popular," yet they do not venture into this territory themselves, leaving the critique incomplete. Without engaging with potential reforms, the piece risks being a lament rather than a constructive analysis.
The article effectively and undeniably highlights real issues with Medicare Advantage, its cost to taxpayers, the constraints it imposes on some beneficiaries, and the challenges of switching back to traditional Medicare. By framing MA’s rise as largely a product of coercion and inefficiency, it overlooks the complex interplay of beneficiary preferences, market dynamics, and policy design that have fueled its growth. A more balanced and thorough critique would have integrated these factors, provided richer data, and offered a path forward, rather than leaving readers with a one-dimensional warning about "privatization’s" perils.
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