Medicare Advantage

The result? Insurers passed costs directly to beneficiaries.

This policy reversal explains the divergence between standalone plans and Medicare Advantage coverage.

Beneficiaries who get drug coverage through Medicare Advantage plans, now representing more than half of all Medicare enrollees, will see average drug-related premium increases of less than $2 monthly to $9 total.

The gap between these two enrollment pathways has never been wider, and it's reshaping how seniors think about their Medicare choices.

The political context matters for marketers.

Price transparency tools that estimate total annual costs, integrating premiums, deductibles, and specific drug prices become table stakes, not differentiators.

Organizations that still lead with low premiums, without contextualizing total out-of-pocket costs, will lose credibility with the 2027 cohort of burned beneficiaries who thought they had affordable coverage.

Medicare Advantage plans, with their $489 average deductible versus $643 for standalone plans, can quantify this advantage.

And so just like he makes sure that my gaps are filled with my home and auto, we are responsible for making sure that someone's gaps are filled with their health insurance and life insurance retirement.

And that's what I think agents need to see is, listen, if you sell in a Medicare Advantage plan, there's gaps in that plan unless they're full Medicaid.

And even with full Medicaid, there's still gaps.

But most people still need something like a hospital indemnity, a cancer plan.

I have to bring this up.

So when they say Medicare for all, that's not what it is because it's Medicare for – if you're on Medicare as a senior citizen or about to get it, it's Medicare for nobody because the Medicare Advantage goes away.

Any private health insurance goes away.

If you worked your ass off assembling Ford F-150 pickup trucks and you have a – cherry health insurance plan in retirement you don't get to keep that yeah think about that goes away based on how some of these bills have been written

I am your host, Daniel Marino.

In today's episode, we're going to talk about Medicare Advantage and dive into some of the some of both the challenges that we're seeing, and especially as we prepare for 2027, just a lot of continued changes, both in terms of how we're structuring a lot of the economics around Medicare Advantage, as well as then how we're taking care of our patients.

Obviously, Medicare Advantage continues to be one of the most important forces that are really driving what we're doing in healthcare.

CMS continues to emphasize the fact that they want to get out of managing Medicare beneficiaries.

And patients are either going to go to Medicare Advantage or they're going to go to an ACO.

I don't know if they're going to hit the 2030 mark, but certainly that is a goal.

At the same time, there's a lot of pressures that healthcare organizations are struggling with.

I think in terms of really being able to manage the risk, the investment, the economics and the revenue associated with Medicare Advantage, as well as then just managing the overall cost structure.

And if I am just, just yell at me and we'll just take a step back.

But the Medicare supplements that we're talking about versus Medicare Advantage, is that any different on the Advantage plans or do you want to finish the supplement stuff first?

Yeah, I'll finish the supplements really quick.

That's kind of our second route is Medicare Advantage.

But with the supplements, you just have a lot more freedom.

There's no network of doctors.

So like my my recommendation is If you have the means, if you have the funds, always start with the most coverage that you can.

It's way easier to move to an Advantage plan or decrease your policy, like decrease what your coverage than it is to gain.

It really shakes up the network for people.

Can I see my doctor with a new insurance company? some same is going on with some medicare advantage plans where there are network negotiations where people are getting notices saying hey you can't see your doctor next year if you don't make a change you can't go to your hospital if you don't make a change and those negotiations are are fueling the confusion for people what do i do what do i do going forward i don't know if i can go here that's where it's tightening up that's where it's really becoming an issue for most people can i see my doctor can i go to this hospital

When we talk about HMO versus PPO, what is that? Because you had to explain it to me.

Oh, boy.

If your plan isn't working for you, you want to go to a different company, a different plan, or even the people who say, my network is changing.

I don't know if I can go to my doctor or my hospital.

It may be a good time to switch from an HMO to a PPO so that you can still go out of network and not have that panic of what do I do? The other thing to keep in mind is right now with the enrollment period, the beginning of the year, the first three months of the year is what they call open enrollment, Medicare Advantage open enrollment.

So if you do make a change.

Their message? Keep your Medicare and choose your plan around everything outside primary care because you still need it for specialists, imaging, hospital stays, and the ER.

And check how a plan handles referrals since some Medicare Advantage HMO plans only cover a specialist if an in-network primary care doctor sends you.

So there, notice what both practices do.

They don't sell a plan.