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Updated: Jun 8, 2025

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Expected Out-Of-Pocket Costs: Comparing Medicare Advantage With Fee-For-Service Medicare.

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  • 1Benedic Ippolito (benedic.ippolito@aei.org), American Enterprise Institute, Washington, D.C.

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Medicare Advantage plans offer lower out-of-pocket costs compared to traditional fee-for-service Medicare. Enrollees in Medicare Advantage saved 18-24% on costs from 2014-2019.

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Area of Science:

  • Health Economics
  • Public Health Policy
  • Gerontology

Background:

  • Medicare is a crucial federal health insurance program in the United States.
  • Understanding the financial implications of different Medicare plan options is essential for beneficiaries.
  • Cost-sharing and premiums significantly impact out-of-pocket expenses for Medicare enrollees.

Purpose of the Study:

  • To compare the generosity of Medicare Advantage and traditional fee-for-service Medicare.
  • To analyze out-of-pocket costs, including premiums and cost-sharing for basic and supplemental services.
  • To evaluate the financial benefits of Medicare Advantage plans for a typical enrollee.

Main Methods:

  • Comparative analysis of Medicare plan generosity.
  • Projection of out-of-pocket costs for a typical enrollee.
  • Inclusion of cost-sharing and premium data for basic and supplemental services.
  • Data analysis spanning the years 2014 through 2019.

Main Results:

  • Projected out-of-pocket costs were 18-24% lower in Medicare Advantage compared to traditional fee-for-service Medicare.
  • This cost reduction was observed for a typical enrollee over the study period.
  • The comparison encompassed both premiums and cost-sharing for all services.

Conclusions:

  • Medicare Advantage plans demonstrate greater generosity in terms of lower out-of-pocket costs for beneficiaries.
  • The findings suggest a significant financial advantage for individuals choosing Medicare Advantage over traditional Medicare.
  • Policymakers and beneficiaries can utilize this information for informed healthcare coverage decisions.