Why are people leaving Medicare Advantage plans during?
Asked by: Brian Willms | Last update: July 12, 2025Score: 4.1/5 (68 votes)
Why are people dropping 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.
Why are seniors losing their Medicare Advantage plans?
Health systems and hospitals are also making the decision to cancel contracts due to excessive prior authorization denial rates and slow payments from insurers. Already 27 health systems have canceled their Medicare Advantage contracts this year.
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.
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 Medicare Advantage Plans?
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 do doctors not accept Medicare Advantage plans?
The most common reason that doctors may discontinue their acceptance of Medicare Advantage is that the private insurance company makes it difficult or time-consuming for the doctor to get paid for their services.
Why do people say not to get a Medicare Advantage plan?
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 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.
Why is Humana discontinuing 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 taking 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 is Medicare Supplement better than Advantage Plan?
Summary: Medicare Advantage offers broader coverage including prescription drugs and dental care, while Medicare Supplement focuses on covering most out-of-pocket costs. Medicare Advantage plans are managed by private insurers with network restrictions, whereas Medicare Supplement allows freedom of provider choice.
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 leaving 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.
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 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 ...
Is original Medicare better than an advantage plan?
More coverage can offer more peace of mind, so you don't get surprise medical bills in the event of a sudden injury or illness. Medicare Advantage plans can also offer more benefits than Original Medicare.
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.
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 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.
What is the alternative to Medicare Advantage plans?
A Medigap policy is a supplement to Original Medicare coverage. When you're getting started with Medicare, you can either buy Medigap or enroll in a Medicare Advantage Plan, but you can't have both. You can't buy Medigap while you're in a Medicare Advantage Plan unless you're switching back to Original Medicare.
What percentage of doctors accept Medicare Advantage plans?
Only about 46% of doctors who work with Medicare will accept any Advantage plan. Even then, they may not accept your Advantage plan. Remember to verify with the doctor's office directly that they still accept your Advantage plan, as network participation can change annually.
Why are hospitals refusing Medicare Advantage plans?
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.
Why is a plan G better than an advantage plan?
Medigap Plan G offers more comprehensive benefits than the Medicare Advantage plan and is more widely available. It also provides more freedom for enrollees. For example, a Medigap Plan G enrollee can visit a specialist without a referral.
What is the two midnight rule for Medicare Advantage?
The two-midnight presumption directs medical reviewers to select Original Fee-for-Service Medicare Part A claims for review under a presumption that hospital stays that span two midnights after an inpatient admission are reasonable and necessary Part A payment.