Why are Medicare Advantage plans losing more providers?
Asked by: Leda Upton | Last update: July 28, 2025Score: 4.3/5 (46 votes)
Why are providers dropping 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.
What companies are pulling out of Medicare Advantage plans?
Plan Exits and Closures
Humana, CVS Aetna, and UnitedHealthcare collectively impact over 1.2 million members due to their plan closures. Eighteen marketing brands — including Premera Blue Cross and Blue Cross and Blue Shield of Kansas City — are exiting the market entirely in 2025, affecting tens of thousands of ...
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 people leaving Advantage plans?
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.
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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.
Why do doctors not like Medicare Advantage plans?
Across the country, provider grumbling about claim denials and onerous preapproval requirements by Advantage plans is crescendoing. Some hospitals and physician practices are so fed up they're refusing to accept the plans — even big ones like those offered by UnitedHealthcare and Humana.
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.
Is Humana pulling out of Medicare Advantage plans?
Humana declined to name the areas; about 560,000 Medicare Advantage beneficiaries impacted. Humana will stop offering Medicare Advantage (MA) in 13 counties in 2025, Humana CFO Susan Diamond said in a published report in Becker's Payer Issues dated Sept.
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 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.
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.
Are there any 5 star Medicare Advantage plans?
The 5-star Special Enrollment Period provides an opportunity for you to switch to a 5-star Medicare Advantage-only plan, a 5-star Medicare Advantage Plan with prescription drug coverage, or a 5-star Medicare Prescription Drug Plan.
Is Mayo Clinic no longer accepting Medicare Advantage plans?
We do not accept noncontracted Medicare Advantage Plans.
Can I drop my Medicare Advantage plan and go back to original medicare?
Medicare Advantage Open Enrollment Period: Between January 1 and March 31 of each year, if you already have a Medicare Advantage Plan (with or without drug coverage) you can: Switch to another Medicare Advantage Plan (with or without drug coverage). Drop your Medicare Advantage Plan and return to Original Medicare.
What percentage of people on Medicare have an Advantage plan?
More than half of eligible Medicare beneficiaries are enrolled in Medicare Advantage in 2024. In 2024, more than half (54%) of eligible Medicare beneficiaries – 32.8 million people out of 61.2 million Medicare beneficiaries with both Medicare Parts A and B – are enrolled in Medicare Advantage plans.
Is Medicare getting rid of Advantage plans?
Many older adults will see their Medicare Advantage plan eliminated next year, but that could be a boon for those who want to exit the program and move to government-run Medicare. Medicare Advantage, the privately run alternative to traditional Medicare, now enrolls more than half of all Medicare beneficiaries.
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 top 5 medicare supplement plans?
💬 From our Nerds: What are the top five Medicare supplement plans? "Based on NerdWallet's Medigap rubric, I picked five best Medicare Supplement Insurance companies for 2025: AARP/UnitedHealthcare, Mutual of Omaha, State Farm, Anthem and Blue Cross Blue Shield.
Why are hospitals not taking Medicare Advantage plans?
Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers. In 2023, Becker's began reporting on hospitals and health systems nationwide that dropped some or all of their Medicare Advantage contracts.
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 biggest disadvantage of Medicare Advantage?
- Plans can also cost more overall than Original Medicare if you have complex medical needs. ...
- With some plans, you don't have any coverage if you use a doctor that isn't in the network.
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.
Why are hospitals dropping Humana Medicare?
Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers. In 2023, Becker's began reporting on hospitals and health systems nationwide that dropped some or all of their Medicare Advantage contracts. 2024 coverage is here.
Does everyone have to pay $170 a month for Medicare?
Most people pay no premiums for Part A. For Medicare Part B in 2025, most beneficiaries will pay $185 per month. Certain factors may require you to pay more or less than the standard Medicare Part B premium in 2025.