What is the most common medical insurance plan used by older adults in the US? Understanding the shift to Medicare Advantage

As of 2025, data from the Kaiser Family Foundation (KFF) indicates that Medicare Advantage has become more common than Original Medicare among eligible beneficiaries. This shift highlights a significant trend regarding what is the most common medical insurance plan used by older adults in the US today, with more seniors opting for private, bundled plans over traditional government coverage.

Quick Summary

Medicare Advantage has surpassed Original Medicare as the most widely used insurance option by older adults, drawing enrollees with bundled benefits and cost-sharing advantages. Understanding the differences, including provider networks and supplemental coverage, is key to selecting the optimal plan. The choice depends on individual healthcare needs, budget, and preference for network flexibility.

Key Points

• Medicare Advantage is now the most common plan: As of 2025, over 50% of Medicare-eligible individuals are enrolled in a private Medicare Advantage (Part C) plan, surpassing Original Medicare.

• Original Medicare offers provider flexibility: Original Medicare (Parts A & B) allows you to see any doctor or hospital nationwide that accepts Medicare, but has no out-of-pocket limit.

• Medicare Advantage offers extra benefits: These private plans often bundle Part A, B, and D coverage with additional benefits like vision, dental, and hearing, which are not covered by Original Medicare.

• Medigap supplements Original Medicare: Individuals with Original Medicare often purchase a Medigap policy to help cover out-of-pocket costs, as well as a separate Part D plan for prescription drugs.

• Network is a key difference: Medicare Advantage plans typically use provider networks (HMOs or PPOs), while Original Medicare does not restrict your choice of providers.

• Financial risk varies by plan: Medicare Advantage includes an annual out-of-pocket maximum, while Original Medicare does not, making supplemental Medigap coverage essential for limiting financial risk.

For many years, Original Medicare was the primary healthcare coverage for older adults in the US. However, the landscape has changed, and the answer to "What is the most common medical insurance plan used by older adults in the US?" is now Medicare Advantage. As of 2025, over 50% of eligible beneficiaries are enrolled in a Medicare Advantage plan. This article delves into the details of both options and the implications of this trend.

Understanding the Two Main Medicare Paths

When becoming eligible for Medicare, individuals can choose between two main avenues:

• Original Medicare: This traditional federal program includes Part A (Hospital Insurance) and Part B (Medical Insurance). Part A covers inpatient care and some home health services, while Part B covers doctor visits, outpatient care, and preventive services. Original Medicare allows flexibility in choosing any provider that accepts Medicare nationwide, but beneficiaries are responsible for deductibles, coinsurance, and copayments.
• Medicare Advantage (Part C): Offered by private insurers approved by Medicare, these plans must provide at least the same coverage as Original Medicare Parts A and B. Most include additional benefits not covered by Original Medicare, such as vision, hearing, dental, and wellness programs, and often integrate prescription drug coverage (Part D). Medicare Advantage plans typically use provider networks like HMOs or PPOs, which can limit provider choice.

The Rise of Medicare Advantage (Part C)

The growth in Medicare Advantage enrollment, from 19% in 2007 to 54% in 2025, signifies its emergence as the most common medical insurance plan for older adults. This shift is driven by several factors, including the convenience of bundled benefits (Parts A, B, and often D, plus extras) in one plan, and the financial protection of an annual maximum out-of-pocket limit. Many plans also offer low or $0 monthly premiums beyond the standard Part B premium, making them an attractive option, particularly for those on a fixed income. Special Needs Plans are also available within Medicare Advantage to cater to specific health conditions or dual eligibility for Medicare and Medicaid.

Medigap: Supplemental Coverage for Original Medicare

For individuals choosing Original Medicare, Medigap policies are available from private companies to help cover out-of-pocket costs such as copayments and deductibles. Medigap plans are standardized and cannot be used with Medicare Advantage. Those with Original Medicare also need a separate Part D plan for prescription drug coverage.

Choosing the Right Path for You

Deciding between Original Medicare and Medicare Advantage requires evaluating personal health needs, budget, and lifestyle. The best choice is not universal.

Comparison Table: Original vs. Advantage

Feature	Original Medicare (with Part D and Medigap)	Medicare Advantage (Part C)
Provider Network	See any doctor or hospital that accepts Medicare nationwide.	Usually restricted to a specific network of doctors and hospitals (HMO or PPO).
Referrals	No referrals needed to see specialists.	Often requires referrals to see specialists, especially with HMO plans.
Extra Benefits	No coverage for vision, dental, hearing, or wellness programs.	Typically includes vision, hearing, dental, and other wellness benefits.
Prescription Drugs	Requires a separate Medicare Part D plan.	Most plans include Part D coverage.
Cost Structure	Higher total monthly premiums (Part B, Part D, Medigap), but often lower out-of-pocket costs at the point of care.	May have low or $0 monthly premiums (in addition to Part B), but relies on copayments and deductibles within the network.
Out-of-Pocket Cap	No annual maximum out-of-pocket limit (Medigap plans can help with this).	Includes an annual maximum out-of-pocket limit for financial protection.
Travel Coverage	Some Medigap policies offer emergency foreign travel coverage.	Limited to the plan's service area, generally the state of enrollment, with some coverage for urgent care outside the area.

Conclusion

Medicare Advantage has become the most common medical insurance plan among older adults in the US, shifting from traditional Original Medicare. While Medicare Advantage offers bundled benefits and potential cost advantages, it often involves more restrictive provider networks. Original Medicare, often supplemented with Medigap and a separate Part D plan, remains a popular choice for those prioritizing provider flexibility, despite potentially higher premiums. The best plan is a personal decision based on individual health needs, preferred providers, and financial considerations.

To learn more about your coverage options directly, visit the official Medicare.gov website(https://www.medicare.gov/health-drug-plans/health-plans/your-health-plan-options).

Frequently Asked Questions

What is the difference between Original Medicare and Medicare Advantage?

Original Medicare is the federal government program that covers hospital (Part A) and medical services (Part B). Medicare Advantage (Part C) is a private, all-in-one alternative that bundles Parts A and B, often includes Part D prescription drug coverage, and provides extra benefits like vision and dental care.

Does Medicare Advantage cost more than Original Medicare?

Not necessarily. Many Medicare Advantage plans have low or $0 monthly premiums (in addition to the standard Part B premium). While Original Medicare has no network restrictions, it has significant out-of-pocket costs, which often require purchasing separate Medigap and Part D plans, leading to higher overall monthly costs for comprehensive coverage.

What is a Medigap policy?

A Medigap, or Medicare Supplement, policy is private insurance that helps pay for the out-of-pocket costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles. It cannot be used with a Medicare Advantage plan.

Do all Medicare Advantage plans include prescription drug coverage?

The vast majority of Medicare Advantage plans include prescription drug coverage (Part D), often referred to as an MA-PD plan. However, some specific plan types, like Medicare Medical Savings Accounts (MSAs), do not include drug coverage.

What factors should I consider when choosing between Original Medicare and Medicare Advantage?

Consider your preferred doctors and hospitals, as Medicare Advantage plans often have network restrictions, unlike Original Medicare. Evaluate your health needs, prescription drug requirements, travel habits, and budget. For those who want more benefits and predictable out-of-pocket costs, Medicare Advantage is appealing, while those prioritizing provider choice may prefer Original Medicare with supplements.

Can I switch between Medicare Advantage and Original Medicare?

Yes, you can switch between plan types during specific enrollment periods, such as the Annual Enrollment Period (October 15 – December 7). You can also make changes during the Medicare Advantage Open Enrollment Period (January 1 – March 31).

How do Medicare Advantage networks work?

Most Medicare Advantage plans are either HMOs (Health Maintenance Organizations) or PPOs (Preferred Provider Organizations). HMOs typically require you to use in-network providers, while PPOs allow more flexibility to see out-of-network providers for a higher cost.