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The Risks and Rewards of Medicare Advantage Plans

Doctor speaking to patient about Medicare Advantage plans

Medicare is a continually growing segment of the healthcare consumer population. In 2020, 18.4% of Americans were covered by Medicare and that number continues to climb with a 9 percent jump in sign-ups already compared to 2021, leading experts to believe it will surpass the government’s predictions for 2022.

The health insurance space has evolved in recent years, but nothing has changed the industry like Medicare Advantage plans. These plans are more lucrative, which means hundreds of health plans are competing in this space based on price and experience. But is it worth it for insurers to consider adding Medicare Advantage plans to their options?

About Medicare Advantage Plans

Medicare Advantage plans, also known as Part C, offer additional coverage than traditional Medicare and cover Parts A, B & normally D. The plans can cover other areas like dental, vision and hearing.

These plans have grown in popularity with enrollment doubling in the last decade. More insurers continue to move into this space and that even includes start-ups that have snatched up enrollments from larger and more established insurers.


There are downsides for consumers to Medicare Advantage plans. Members can’t go out of their network for care like they could with traditional Medicare and they need approvals for specific services in order for them to be covered. And depending on the situation, members may have to get a referral to see a specialist.

But the risk to insurers of not getting into the Medicare Advantage space is large with the number of people eligible for Medicare continuing to grow.


Medicare Advantage Plans offer a lot of benefits for both members and insurers. Unlike traditional Medicare, there are more coverage options with drug costs and other health benefits. Out of pocket costs can be less than traditional Medicare too and once the yearly limit is hit, members don’t pay any more in costs. Plus, premiums have been going down for members in recent years.

As for insurers, members who have Medicare Advantage plans have less inpatient spending and utilization than those with traditional Medicare plans. On top of the number of people that continue to enroll in these plans, it’s a compelling option for insurers to add to their offerings.


The amount of people eligible for Medicare has been surging for years with an average of 10,000 people per day becoming eligible for Medicare. When a growing chunk of that space involves Medicare Advantage plans, it’s hard to ignore the opportunity.

As an insurer, Medicare Advantage plans offer another route to pull in more members and while there are many approaches to doing that, acquisition and loyalty efforts that involve segmenting members through methods like psychographic segmentation are key to pulling on member motivations. Psychographic segmentation also enables an insurer to anticipate which members are more (or less) likely to pursue healthy habits and preventative care for risk management.

Through PatientBond’s multi-channel communications platform, insurers can:

  • Increase member actions and enhance engagement
  • Increase Open Enrollment acquisition and loyalty
  • Improve care plan adherence

Insurers can create member workflows unique to the consumer that adjust based on consumer preferences in real-time. Plus, healthcare consumer data is at the insurer’s fingertips with the PatientBond Insights Accelerator™ to better understand their members and pull in new ones.

There are plenty of reasons to pursue Medicare Advantage plans and PatientBond can help insurers navigate the space with the help of our tools, like member segmentation to customize outreach.

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