Medicare beneficiary out-of-pocket costs: are Medicare Advantage Plans a better deal?

Brian Biles, Lauren Hersch Nicholas, Stuart Guterman Stuart

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


The creators of the Medicare Advantage (MA) program envisioned that seniors would opt out of fee-for-service Medicare to take advantage of the lower premiums, lower cost-sharing, and additional benefits available in private plans. Earlier research, however, indicates that out-of-pocket costs for MA enrollees vary widely by health status and plan benefit package. This issue brief examines out-of-pocket costs for beneficiaries in good, fair, and poor health throughout the country. In 2005, annual out-of-pocket costs for plan members ranged from under $100 for beneficiaries in good health to over $6,000 for those in poor health. Costs for beneficiaries in poor health would actually have been higher than fee-for-service in 19 of the 88 MA plans examined. Despite the high payments, relative to fee-for-service costs, that MA plans receive from Medicare to enrich enrollee benefits, these plans may not always be a good deal for sicker beneficiaries who use more health services.

Original languageEnglish (US)
Pages (from-to)1-16
Number of pages16
JournalIssue brief (Commonwealth Fund)
StatePublished - May 2006
Externally publishedYes

ASJC Scopus subject areas

  • General Medicine


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