Privately provided Medicare plans that have grown rapidly in popularity: more than half of Medicare beneficiaries now use them, compared with a quarter in 2010. They often provide appealing vision, hearing and dental benefits not available through traditional Medicare.
Despite typically having healthier enrollees, Medicare Advantage plans end up costing the government more than traditional Medicare. Insurers receive higher payments when patients are sicker, which pushes plans to present people as sicker than they really are. Covering someone under Medicare Advantage costs 20% more than covering the same person under traditional Medicare, which resulted in $84bn in additional government spending in 2025.
Reforms could make it harder for plans to exaggerate patient illness. A Congressional Budget Office report estimated potential savings at anywhere from $124bn over ten years to over $1trn, depending on the ambition of the reforms. The White House has some options to enact changes through the administration of Medicare, but that path would probably be highly litigated and the scale of available savings would be limited. Touching Medicare Advantage carries political risks because it is a popular, bedrock programme about which older voters are passionate.
It's bad enough that life is a rat-race, but why do the rats always have to win?