Mark Cuban Has a Warning About Medicare Advantage - Here’s What It Means for Your Open Enrollment Decision

Mark Cuban thinks Medicare Advantage has become too expensive for taxpayers. His argument is that private Medicare plans were supposed to save the government money, but he says Medicare now pays insurers more than it would cost to cover the same people through traditional Medicare. Cuban puts that extra cost at roughly $800 a year for every American family.

That doesn't automatically mean you should drop Medicare Advantage. Cuban is talking about what the program costs the government. Your own choice comes down to what a plan costs you, which doctors you can see, which drugs it covers, and what hoops you may have to jump through to get care. Medicare Open Enrollment runs from October 15 through December 7. Here's what to consider before making a change so you can make sure you make the right moves.

Editor's note: Medicare payment estimates cited in this article come from the Medicare Payment Advisory Commission (MedPAC), unless otherwise stated. Plan costs, networks, drug coverage, and benefits vary by plan and location.

Why Cuban is sounding the alarm

There is a real spending gap behind Cuban's warning. MedPAC estimates that Medicare Advantage plans will receive 114% of what Medicare would have spent on the same beneficiaries in traditional Medicare in 2026. That works out to about $76 billion in additional Medicare spending. Cuban's $800 figure is his way of putting that national cost into household terms.

Insurers say the numbers miss part of the picture

The Medicare Advantage industry sees it differently. Better Medicare Alliance, which represents and advocates for the program, says the comparison leaves out costs and benefits that make Medicare Advantage and traditional Medicare difficult to compare directly. Its list includes Part D and Medicaid spending, extra benefits, and possible savings from preventive care and care coordination.

Risk adjustment can change the numbers

Medicare Advantage plans get more money for people who are expected to need more medical care. That's the basic idea behind risk adjustment. MedPAC says differences in diagnosis coding and the health of people who choose Medicare Advantage contribute to higher payments. Industry groups argue that newer data from the Centers for Medicare & Medicaid Services (CMS) shows a smaller coding difference than MedPAC has estimated.

Extra benefits are part of the deal

Medicare Advantage can also include coverage that Original Medicare does not normally provide. Plans may offer extras such as dental, vision, and hearing benefits, and CMS says rebate money can be used for supplemental benefits and lower premiums. That doesn't answer whether Medicare is paying too much, but it is part of what beneficiaries receive in return.

Cuban wants more of the deals made public

Cuban has another concern: even if insurers negotiate lower prices, he doesn't believe those savings will necessarily reach the people they cover. He has argued that giving insurers more bargaining power does not guarantee lower costs for plan holders. His proposed fix is to require insurers and hospitals to make their contracts public so the negotiated prices are easier to see.

Check whether your doctors are still in network

For your own plan choice, start with the doctors and hospitals you use. Medicare Advantage plans can limit you to a provider network or charge more when you go outside it, depending on the type of plan. Medicare recommends that you ask your doctors and pharmacies whether they participate in a plan before you join. Don't assume last year's network is still intact.

Look at the prior authorization rules

Next, find out which services need the plan's approval before you receive them. Medicare Advantage plans may require prior authorization for certain services and medical supplies. Original Medicare usually doesn't require prior authorization in most cases. This can matter if you regularly need specialist care, scans, therapy, medical equipment, or other ongoing treatment.

Run every prescription through the plan

Don't stop at checking whether the plan includes drug coverage. Look up the medications you actually take. Medicare advises people comparing plans to enter their regular prescriptions to get more accurate estimates of their monthly and yearly costs. A drug can still cost very different amounts from one plan to another, depending on the formulary, pharmacy, and coverage rules.

Don't ignore the out-of-pocket maximum

A $0 premium sounds good, but it doesn't tell you what an expensive year could cost. Medicare Advantage plans have a yearly limit on what members pay for covered Medicare services, and the amount varies by plan. Original Medicare has no yearly out-of-pocket limit unless you have other coverage, such as Medigap. Compare that maximum alongside the monthly premium and copays.

Think about Medigap before you leave Medicare Advantage

Switching back to Original Medicare is possible, but buying Medigap afterward may not be as simple. Outside certain protected periods, a Medigap insurer can charge more or deny your application if you don't meet its medical underwriting requirements. There are exceptions. For example, some people who leave Medicare Advantage during their first year have special Medigap rights. Check before you switch, not afterward.

Read your Annual Notice of Change carefully

Your plan's Annual Notice of Change tells you what will change in its coverage, costs, and other terms starting in January. Put it next to your current plan information and check the premium, deductible, copays, out-of-pocket limit, doctors, hospitals, prescriptions, pharmacies, and extra benefits. If something you depend on has changed, you have until Dec. 7 to change your Medicare coverage during Open Enrollment.

Bottom line

Cuban's warning is worth understanding, but it doesn't tell you which Medicare option will work best for you. His complaint is about how much the federal government spends on Medicare Advantage. Your decision should be based on what you will pay, which doctors and drugs are covered, and how the plan works when you actually need care.

If you're stuck between plans, you don't have to rely on an insurance salesperson for help. State Health Insurance Assistance Programs offer free, personalized Medicare counseling and aren't connected to an insurance company or health plan. That's particularly useful if you're considering a move back to Original Medicare and need to prepare yourself financially and understand your Medigap options before making the switch.

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