A quiet but profound tipping point was just reached in American senior healthcare. For the first time, Medicare Advantage now covers 54% of all eligible beneficiaries, which is about 34.1 million people[44]. What was once the "alternative" has officially become the new standard. This is more than a statistic. It's a fundamental transformation in how healthcare for seniors is paid for and delivered, creating huge opportunities for companies that are built for this new world.
Why the Switch?
Seniors are voting with their feet for a simple reason: Medicare Advantage plans are often a more comprehensive and predictable product. They usually include dental, vision, and drug coverage, and they cap out-of-pocket costs. In fact, 76% of enrollees pay no additional premium beyond their Part B contribution[45]. Most importantly, they are built around coordinated care. The plans have a powerful financial incentive to keep patients healthy and manage their care proactively, rather than letting them navigate a fragmented system on their own.Value-Based Care in Action
This is where the real change is. MA plans get paid a fixed amount per member. They make money by keeping people healthy and out of the hospital, not by ordering more tests. This model is a perfect fit for providers like our portfolio company, Complete Health[46]. Their entire practice is designed to thrive in this world. They offer longer appointments, employ care coordinators to manage follow-ups, and use technology to identify at-risk patients before they get sick. Their incentives are perfectly aligned with their patients' best interests. The growth of Medicare Advantage is forcing innovation everywhere, from primary care to home health, like at companies such as THEMA Health Services[47]. The message for every healthcare organization is now clear: adapting is no longer optional. Success now depends on proving you can deliver better outcomes at a lower cost. The transition from volume to value is no longer a future trend; it is today's reality.References
- Kaiser Family Foundation Medicare Advantage enrollment data, https://www.kff.org/medicare/issue-brief/medicare-advantage-2025-enrollment-update (2025, 54% of eligible beneficiaries) ↩
- KFF Medicare Advantage premium statistics, https://www.kff.org/medicare/issue-brief/medicare-advantage-2025-premiums (2025) ↩
- Complete Health portfolio description, https://pharosfunds.com/complete-health.php ↩
- THEMA Health Services portfolio description, https://pharosfunds.com/thema-health-services.php ↩
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