Medicare Advantage Benefit Design: What Does It Provide, What Doesn't It Provide, and Should Standards Apply?

This report offers a more detailed look at Medicare Advantage (MA) benefit structures and how they compare to standard Medigap options. MA plans simplify cost sharing for Medicare Part A and B benefits, with most plans eliminating inpatient day limits and shifting from deductibles and coinsurance towards fixed dollar copayments. Though benefits vary across plans, MA enrollees typically receive much less financial protection against high out-of-pocket costs than Medigap offers. Supplemental benefits tend to reduce cost sharing for preventive care and provide a limited amount of coverage for relatively predictable needs such as eyeglasses, hearing aids, and preventive dental care. Findings also highlight the wide variability in benefit structures across MA plans, even of the same type, and some challenging distinctions that beneficiaries are asked to make when comparing these plans and original Medicare.