Seniors Choose Medicare Advantage for Better Care at Lower Costs – Protecting their Benefits is Critical
More than 34 million seniors and individuals with disabilities choose Medicare Advantage (MA) over fee-for-service (FFS) for their Medicare coverage because MA consistently provides better care for lower costs. Seniors are savvy consumers who understand the differences – and that’s why a growing majority choose MA.
As the Centers for Medicare & Medicaid Services (CMS) finalizes its policies for the 2026 MA program, it’s essential to recognize the negative consequences seniors will experience if policymakers underfund this vital part of the Medicare program.[1] Here’s what’s at stake:
Greater Affordability: Seniors Choosing Medicare Advantage Save More than $2,500 Annually[2]
With hospital and prescription drug prices continuing to rise,[3] comprehensive health care coverage is more important than ever. Patients who choose an MA plan spend far less, on average, in premiums and out-of-pocket costs than those with FFS Medicare. In 2021, total spending on premiums and out-of-pockets in MA was $3,861 annually compared to $6,402 in FFS Medicare – meaning MA beneficiaries save more than $2,500 per year over those in FFS on average. Erosion of these savings under MA would be devastating for millions of MA beneficiaries living on low and fixed incomes.
More Security and Peace of Mind: Medicare Advantage Protects Seniors with an Out-of-Pocket Maximum
FFS Medicare does not protect seniors with an out-of-pocket maximum for the services covered under Part A and Part B, including hospital stays, outpatient surgeries and doctor visits. This means there is no limit on how much seniors could pay out-of-pocket for these services.
In contrast, MA protects seniors from unexpected costs with an average out-of-pocket maximum. For 2025, the out-of-pocket maximum for MA plans set by CMS is $9,350 for in-network services, but individual MA plans can and do set lower limits. In fact, 94% of MA plans have a maximum out-of-pocket limit below the CMS limit,[4] and the median maximum out-of-pocket limit for beneficiaries in 2025 is $5,400.[5] The maximum out-of-pocket limit offered by MA plans provides financial security for patients when they need it the most.
Additional Benefits: Medicare Advantage Promotes Greater Health and Wellness
For many seniors, MA’s emphasis on preventive care and chronic care management set it apart from traditional FFS Medicare. Patients report higher use of preventive care services – such as breast and colorectal cancer screenings[6] – and nearly all (at least 97%) MA plans offer dental, eye and hearing benefits.[7] And now more than 95% of MA plans include fitness benefits for seniors to help support healthy, active lifestyles. It’s no surprise then that patients with more complex health care needs choose MA over FFS Medicare with MA’s comprehensive, coordinated care leading to better outcomes for seniors.[7], [8]
Real Value: Medicare Advantage Offers Seniors More, For Less
Simply put, a growing majority of seniors choose MA because it provides better and more coordinated care, more comprehensive benefits, better outcomes and increased savings and financial security compared to FFS Medicare. For most Medicare-eligible patients, these advantages are available for no additional premium. Nearly all MA beneficiaries (99%) have access to an MA prescription drug plan with no additional monthly premium in 2025.
Taken altogether, it’s very clear why, year after year, MA earns high satisfaction rates from seniors.[9]
To learn more about Medicare Advantage, visit https://www.ahip.org/issues/medicare-advantage.
[1] https://www.ahip.org/news/articles/underfunding-medicare-advantage-would-compound-the-impact-of-two-years-of-cuts
[2] https://bettermedicarealliance.org/wp-content/uploads/2024/06/BMA-Medicare-Beneficiary-Spending-2024-FIN.pdf
[3] https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet
[4] https://www.ahip.org/resources/5-things-to-know-about-medicare-advantage
[5] https://bettermedicarealliance.org/wp-content/uploads/2024/10/Analysis-of-the-2025-Medicare-Advantage-Plan-Landscape.pdf
[6] https://www.ahip.org/resources/medicare-advantage-provides-higher-quality-of-care-and-better-rates-of-preventive-service-than-fee-for-service-medicare
[7] https://www.kff.org/medicare/issue-brief/medicare-advantage-2025-spotlight-a-first-look-at-plan-premiums-and-benefits/
[8] https://www.ahip.org/news/press-releases/new-research-ma-enrollees-have-better-outcomes-than-people-in-original-medicare
[9] https://bettermedicarealliance.org/medicare-advantage/about-medicare-advantage/