Why is Aetna canceling Medicare Advantage plans?
Asked by: Miss Florine Johnston DDS | Last update: April 16, 2025Score: 4.6/5 (15 votes)
Is Aetna Medicare Advantage going away?
Everyone currently enrolled in an Aetna Medicare Advantage Plan that is shutting down in 2025 will lose their current coverage on January 1, 2025.
Why are Medicare Advantage plans being canceled?
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 insurance companies leaving Medicare Advantage plans?
Facing financial and federal regulatory pressures, many insurers are pulling their Medicare Advantage plans from counties and states they've deemed unprofitable.
What states is Aetna pulling out of?
Aetna is planning to withdraw their participation in 11 states, including Texas, South Carolina, Pennsylvania, Ohio, North Carolina, Missouri, Kentucky, Illinois, Georgia, Florida, and Arizona, as the provider suffered major financial losses due to high-risk patients in the regions.
Aetna is Canceling Medicare Plans: Are You Affected?
Why did Aetna cancel my Medicare Advantage plan?
Why do Medicare Advantage plans get discontinued? Some plans are discontinued to make room for new plans. Other plans are discontinued so we can update plan benefits to better serve members.
Is Aetna insurance in financial trouble?
Aetna's revenues hit $33 billion in Q3, up from $26.3 billion in Q3 2023. But it posted an adjusted operating income loss of $924 million this year. Its Medical Benefits Ratio was 95.2% in the quarter, compared to 85.7% in the same period last year.
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.
Which company has the best Medicare Advantage plan?
- Best Overall, Best for Low Costs: Cigna.
- Also Great for Low Costs: Alignment Health.
- Best for Nationwide Coverage: Aetna.
- Best for Patient Experience, Best for Drug Coverage: Kaiser Permanente.
- Best for Special Needs Plans: Humana.
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.
What is happening to Medicare Advantage plans in 2025?
Beginning January 1, 2025, people with Part D plans through traditional Medicare and Medicare Advantage plans with prescription drug coverage won't pay more than $2,000 over the calendar year in out-of-pocket costs for their prescription medications.
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.
Is Mayo Clinic no longer accepting Medicare Advantage plans?
We do not accept noncontracted Medicare Advantage Plans.
Is Aetna likely to lose Medicare Advantage members?
Major Medicare insurance carriers are already talking about exiting markets due to a lack of profitability or, at minimum, significantly reducing benefits. For example, CVS Health Aetna is preparing to make such significant changes to its 2025 Medicare Advantage plans that it anticipates losing 10% of its membership.
Is Aetna Medicare Advantage better than Medicare?
Medicare Advantage plans can offer richer benefits at a more reasonable price, because they harness the power of coordinated care within a network of providers. But keep in mind not every doctor or hospital is part of your network, and if I a provider is outside your network, their services may not be covered.
Who is 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 ...
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.
Are there any 5 star Medicare Advantage plans?
"There isn't one Medicare Advantage plan that's the highest-rated; there are multiple plans that get an overall rating of 5 stars, which is the highest rating from CMS.
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.
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 are people leaving Medicare Advantage plans during?
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.
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.
What is happening to Aetna?
CVS is removing Brian Kane, the head of Aetna, citing the division's poor performance and outlook. CEO Karen Lynch, who was the president of Aetna from 2015 to 2021, will now lead the business, while CFO Tom Cowhey will help oversee its day-to-day operations.
Who bought out Aetna?
2017: On December 3, 2017, CVS Health announced the acquisition of Aetna for $69 billion. Larry Merlo became chief executive of the two brands. Aetna CEO Mark Bertolini resigned and Aetna President Karen S.
Why is Aetna denying claims?
If your health or disability benefits have been denied, Aetna may have claimed the following: The procedure is merely cosmetic and not medically necessary. The treating physician is out of network or out of plan. The claim filed was for a medical condition that isn't authorized or covered.