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Quratulain “Annie” Syed, M.D., is an Atlanta geriatrician who has taken care of patients via both original Medicare and MA plans. She’s sold on MA. These plans give practitioners “more

ability to innovate the care, compared to the standard practice,” Syed says. She points to the emphasis on preventive care by MA plans, their ongoing communication with members and the free

transportation that some plans offer. Together, these offerings increase the chance of enrollees seeing their doctors more often. Patients who visit her only once or twice a year bring “a

whole laundry list of problems,” Syed says. Quratulain “Annie” Syed, M.D., treats a patient in Atlanta, Georgia. Andrew Hetherington The extra benefit aspect in MA plans has roots in the

1980s. But the benefits proliferated after 2003, when Congress deemed that if MA plans were able to provide medical care to members for less than what Medicare paid them, the extra money

should be put toward either providing extra services or cutting patients’ costs. Sheereen Aarif first got on Medicare in 2006, when a heart condition disabled her. She was on original

Medicare, but when she moved to be with her sons in Douglasville, Georgia, an adviser suggested she consider an MA plan. The 69-year-old retired engineering technician is glad she did. The

main reason she switched, Aarif says, was the transportation benefit. Her cardiologist is 45 minutes from where she lives. “My children work, and I have no way of getting around. I don’t

drive.” She couldn’t continue to afford the Lyft costs. Now her plan offers her five round-trip rides each year. Aarif was also pleased to find out that the MA plan would keep tabs on her

annual screenings and even whether she exercised. And her physical activities came with a bonus. “I went to the senior center before COVID and did exercises and line dancing. We got points

for that.” Those points, it turned out, were convertible into a gift card that the plan sent her just in time to do Christmas shopping. About 40 percent of Humana’s 4.9 million MA plan

members have the transportation benefit, according to company spokesman Jim Turner. But do enrollees use such offerings? MA plans do not generally report this data, but Turner said that

about 18 percent of those who joined Humana in 2021 had already used their over-the-counter drug discount cards through July — a benefit not offered by original Medicare. And about 80

percent of Humana members who are dually eligible for Medicare and Medicaid (the federal-state health program for those with low income) use the Healthy Foods Card, which provides qualifying

members with a $75-a-month food allowance. United Healthcare, the nation’s largest provider of Medicare Advantage plans (many of which carry the AARP brand), says its “Medicare Advantage

plans go beyond traditional health care services to try to help address the issues outside the doctor’s office that impact people’s health, such as food security, housing, transportation and

social support.” Another example: United and other MA plans have begun offering programs that provide members the ability to have licensed medical staff come to their home. THE QUESTION OF

CARE Extra benefits aside, some experts cite a potential downside to the restrictions in MA plans: members’ limited choices for specialist doctors or hospitals. This comes into play

particularly when there is a need for a more serious or unique treatment for health issues ranging from cancer to joint replacements; patients in an MA plan often don’t have the option to go

to a top-grade but out-of-network research hospital or specialist unless they are willing to pay far more of the costs themselves. A 2021 report by the Government Accountability Office

looked at whether people with complicated health issues may not be as satisfied with MA plans. The report found that “beneficiaries in the last year of life disproportionately disenrolled”

and went back to original Medicare. The report also said that such moves “increased Medicare spending by hundreds of millions of dollars.” The reason: While the government pays MA plans a

flat rate to care for enrollees, original Medicare pays health care providers directly for services rendered, and people near life’s end often generate huge amounts of medical costs.

Medicare pays for hospice care for people near the end of life, whether in original Medicare or an MA plan. David Lipschutz, associate director of the Center for Medicare Advocacy, says that

while some studies show MA plans do better when it comes to preventive care, other studies show “people who are sicker tend to disenroll at a higher rate than those who are not sick. That

is, to me, very telling.” Alicia Jones, director of the State Health Insurance Assistance Program (SHIP) in Nebraska, says that in her experience, people who have had a history of serious

illnesses will more often opt for original Medicare with a Medigap policy because they want predictability when it comes to costs. “They like to know exactly what they are going to be

spending,” she says. A Medigap policy “might be a little more expensive, but it does mean you know exactly every month what it’s going to cost.” Roughly 34 percent of original Medicare

enrollees buy supplemental Medigap coverage; another 29 percent of enrollees get supplemental coverage through an employer-sponsored retiree benefit. Under MA plans, there may be copays and

other out-of-pocket costs that are less predictable. That said, MA plans have a cap on annual out-of-pocket costs (in 2021, that was $7,550). At the Medicare Rights Center, there have been

several common themes to the complaints received from beneficiaries over the past decade, says Casey Schwarz, the advocacy group’s senior counsel for education and federal policy. “More

people who call because they are dissatisfied with their MA plan largely have complaints about affordability, about networks, about denials,” Schwarz says. “For example, they may have low

out-of-pocket costs when they have relatively few health care needs. But if they become sicker, their out-of-pocket costs can be larger.” Often the most pressing concern Schwarz’s counselors

hear about, she says, is from consumers who want to switch out of an MA plan because they want to see a doctor who is not in their plan’s network.