Medicare Advantage

[citation needed] As of 2024, MA enrollees faced premium and out-of-pocket costs that were $2541 less than those in traditional Medicare.

[7]: 61 MA plans are required to offer coverage that meets or exceeds the standards set by Medicare A and B, but do not have to cover every benefit in the same way.

MA plans feature an out-of-pocket annual spending limit of the beneficiary's choosing, typically ranging from $1500 to $8000 (2023).

[citation needed] MA plans may choose to pay for deductibles, including those that apply to some covered medications.

Premiums and plan availability vary by state and county and are annually subject to change.

Many purchase private Medicare Supplement Plans[10] which cover co-pays, co-insurance and/or deductibles.

[citation needed] Plans must be approved by the Centers for Medicare and Medicaid Services (CMS).

Medicare is typically available to those aged 65 and older, certain individuals with disabilities, and those with end-stage renal disease or ALS.

[15] Medicaid eligibility is income and asset-based, varies by state, and is generally available to low-income individuals.

[16] The CMS Innovation Center's Medicare Advantage Value-Based Insurance Design (VBID) model tests customized benefits that are designed to better manage disease and address social needs, including food insecurity and social isolation.

[6] In 2019, MA operators denied 13% of prior authorization requests that would have been accepted under traditional Medicare.

The analysis calculated that in the three years ending in 2021, insurers pocketed $50 billion from Medicare for untreated diseases.