Why are hospitals dropping Humana medicare advantage plans?
Asked by: Prof. Alan Kris V | Last update: July 24, 2025Score: 5/5 (18 votes)
Why is Humana losing Medicare Advantage plans?
To protect profits, Humana and its peers in MA slashed their plans for 2025, cutting benefits and exiting underperforming markets. Plans appear to have focused cuts around supplemental benefits like over-the-counter and flex cards, which give seniors funds to spend on eligible items.
Why are hospitals not accepting Medicare Advantage plans?
Health systems have cited delayed reimbursements, cumbersome prior authorization requirements and high rates of patient claim denials for their decisions to drop Medicare Advantage plans.
Why are Medicare Advantage plans being cancelled?
The purpose of insurance companies running Medicare Advantage plans is to make money, pure and simple. Seniors across the country rely on these plans — yet the record shows that insurers don't value the quality and affordability of care, and don't want beneficiaries to use the medical services they need.
Why are doctors dropping Medicare Advantage?
Providers often argue that Medicare Advantage plans impose restrictions that can hinder patient care. Low reimbursement rates, complicated billing recesses and stringent pre-authorization requirements have pushed CFOs to their boiling point.
Medicare Advantage routinely denies reimbursements for necessary care, hospital execs say
Who is the largest Medicare Advantage provider?
- UnitedHealthcare is the largest provider of Medicare Advantage plans. ...
- Aetna is a CVS Health company and is the fourth-largest provider of Medicare Advantage plans.
Why are seniors losing Medicare Advantage plans?
Medicare vs Privatized Medicare Advantage
Beneficiaries are tossed aside because they live in an unprofitable market for their insurer or because they are actually using the insurance they signed up for to access services.
What states is Humana pulling out of?
Similarly, because of CVS Health Aetna's moves, Humana now feels secure with losing 5% of its Medicare Advantage plan enrollees after it exits unprofitable markets, primarily in the Southeastern states of Florida, North Carolina, Georgia, Texas, and Illinois.
Why are people leaving Medicare Advantage plans?
Key takeaways: People leave Medicare Advantage plans because out-of-pocket costs vary between plans, network restrictions can cause frustration, prior authorization requests can delay care, and it can be difficult to use the additional benefits they provide.
What went wrong with Humana?
Humana's stock dived when it announced a sharp decline in memberships for the top-rated Medicare Advantage (MA) plan. There are serious concerns among investors that the company may not be as attractive an income investment play as it used to be. Humana earns revenue through healthcare services and health insurance.
What are the disadvantages of Humana Medicare Advantage?
Disadvantages of Medicare Advantage plans can include difficulty switching out of the plans later, restrictions on care access, limited provider networks, and limitations on extra benefits.
What is going on with Humana insurance for seniors?
Humana, the country's second largest Medicare Advantage insurer, is aggressively culling its plan offerings after several quarters of spending more than expected on its members' medical care, and getting hammered on Wall Street for it.
Why is Humana cancelling Medicare Advantage plans?
Rising medical costs and lower reimbursements from CMS led Humana and other insurers to plan market exits in 2025.
Does Mayo Clinic accept Medicare Advantage plans?
Yes, Mayo Clinic is a participating Medicare facility in Arizona, in Florida, in Rochester, Minnesota, and at all Mayo Clinic Health System locations. We accept original or traditional Medicare (Parts A, B, and D), as well as supplements. We do not accept noncontracted Medicare Advantage Plans.
Did UnitedHealthcare buy out Humana?
United HealthCare Corp.'s acquisition of Humana Inc., once valued at $5.5 billion, has been derailed by a plunge in United's stock price. The companies said today that they mutually agreed to scrap the deal, which would have created one of the nation's largest managed-care companies.
Why are hospitals not taking Humana Medicare Advantage?
Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers. Some systems have noted that most MA carriers have faced allegations of billing fraud from the federal government and are being probed by lawmakers over their high denial rates.
Is Humana in trouble financially?
Humana shares, among the sector's most hard hit, have fallen nearly 44% so far this year, after the company withdrew its 2025 forecast previously, citing disappointing government Medicare reimbursement rates.
What is the two midnight rule for Humana?
What is the two-midnight rule? The two-midnight rule, enacted in 2013, states that traditional Medicare must pay for an inpatient stay if admitting clinicians anticipate patients will remain in the hospital for at least “two midnights.” Beginning this year, Medicare Advantage insurers must also follow the rule.
Do all hospitals accept Medicare Advantage plans?
While most hospitals do accept Original Medicare, there may be some that do not accept Medicare Advantage Plans. However, if you have a medical emergency while you're enrolled in a Medicare Advantage plan, you can seek care at any ER or hospital in the country.
What is happening to Medicare Advantage plans in 2025?
In 2025, Medicare Part D plans and Medicare Advantage plans that include prescription drug coverage will feature lower out-of-pocket cost limits and new payment options. Changes include: Annual out-of-pocket cap reduced from $8,000 to $2,000. Elimination of the Medicare donut hole in 2025.
Why are payers exiting Medicare Advantage?
BCBS Kansas City exited the Medicare Advantage market at the end of 2024, citing increasing regulatory requirements and financial headwinds. Aetna is bracing to lose up to 10% of its more than 4 million Medicare Advantage members in 2025 as it prioritizes profitability, executives said in May.
What is the biggest disadvantage of the Medicare Advantage plan?
Medicare Advantage Plan Pros And Cons
One disadvantage is that some Medicare Advantage plans may offer fewer options when it comes to doctors and hospitals, as they may have smaller plan networks than Original Medicare.
Which health insurance denies the most claims?
According to the analysis, AvMed and UnitedHealthcare tied for the highest denial rate, with both companies denying about a third of in-network claims for plans sold on the Marketplace in 2023, respectively.
What is the best Medicare plan that covers everything for seniors?
Original Medicare with Medigap likely offers the most comprehensive coverage, but it may also be the most costly. A person can consider their income and how much they are able to spend before choosing a Medicare plan. Original Medicare with Medigap also offers a lot of flexibility when choosing a doctor or specialist.