FOR HOSPITALS & PROVIDERS

Hospitals are the Patient Advocate

Senior patients face a difficult task every year – deciding if they should enroll in Original Medicare or select Medicare Advantage. Hospitals and health systems are advocates for patients during Medicare open enrollment. Print and share these one-pagers with your patients to help educate and guide them during open enrollment.

Comparing Original Medicare & Medicare Advantage Plans (pdf)

Hospital and Provider Education

Providers and other hospital leaders recognize that every patient has unique needs. Here is a deeper dive into some relevant information as you consider what is right for your hospital, your practice and your hospital and patients.

The High-Level Points

Original Medicare and hospital-based Medicare Advantage Plans allow patients to continue visiting their trusted hospitals and hospital-based providers.
Original Medicare with a supplement may be a better choice for seniors with chronic conditions, frequent hospital stays, rehabilitation or long-term care needs.
Medicare Advantage plans may be a better choice for seniors who are relatively healthy and embrace wellness activities.
Many hospitals across the nation are choosing not to accept certain Medicare Advantage plans, due to their high number of delays, denials or postponement of care.

Pro Tip: Remember that regardless of whether the patient with Medicare Advantage is in network or out of network at your hospital, prior authorization will be required for non-emergency health services and coverage could be denied.

By The Numbers

Payers who own Medicare Advantage plans aggressively market these plans directly to those eligible for Medicare, especially during open enrollment time. As a result, more individuals are choosing Medicare Advantage over Original Medicare compared to 10 years ago. While premiums may be lower and the “bundled” nature of Medicare Advantage plans may seem attractive, the complex nature of Medicare Advantage plans is driving up the cost of healthcare and many patients are faced with suddenly becoming out-of-network or having excessive out-of-pocket costs with Medicare Advantage plans.

More than half of eligible Medicare beneficiaries are enrolled in Medicare Advantage in 2025.

In 2025, more than half (54%) of eligible Medicare beneficiaries – 34.1 million out of about 62.8 million Medicare beneficiaries with both Medicare Parts A and B – are enrolled in Medicare Advantage plans. Medicare Advantage enrollment as a share of the eligible Medicare population has jumped from 19% in 2007 to 54% in 2025 (Figure 1).

Between 2024 and 2025, total Medicare Advantage enrollment grew by about 1.3 million beneficiaries, or 4%– a somewhat smaller growth rate than the prior year (7%). The Congressional Budget Office (CBO) projects that the share of all Medicare beneficiaries enrolled in Medicare Advantage plans will rise to 64% by 2034 (Figure 2).

Nearly 7.3 million Medicare beneficiaries are enrolled in special needs plans (SNPs). SNPs restrict enrollment to beneficiaries with significant or relatively specialized care needs, or who qualify because they are eligible for both Medicare and Medicaid. SNPs comprise a growing share of Medicare Advantage enrollment, accounting for 21% of enrollees in 2025 compared with 14% of enrollees in 2020, reflecting small, but steadily year-over-year increases (Figure 3).

Source: Kaiser Family Foundation

Medicare Open Enrollment for 2026 happens Oct. 15-Dec. 7, 2025, with coverage starting Jan. 1, 2026.

Now is the time to make sure you’re choosing the best Medicare option for you in 2026.

To learn more visit Medicare.gov.