Why is Aetna cancelling Medicare Advantage plans?
Asked by: Casey Schiller | Last update: June 16, 2025Score: 4.1/5 (7 votes)
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.
What changes are coming to Aetna Medicare Advantage plans in 2025?
In 2025, Aetna Medicare will merge its three individual PDP products into a single plan — SilverScript® Choice (PDP) — available in all 50 states and D.C. The SilverScript Choice (PDP) will offer a $0 monthly plan premium to members with full Extra Help in 33 states and D.C. SilverScript Choice (PDP) premiums will ...
Why are providers 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 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.
Aetna is Canceling Medicare Plans: Are You Affected?
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.
Is Aetna dropping advantage plans?
You'll lose your current Aetna Medicare Advantage coverage. Beginning January 1, 2025, you'll only be covered by Original Medicare, which doesn't include additional benefits.
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.
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.
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.
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.
Where does Aetna rank?
By membership and revenue, Aetna is ranked third in the country for health insurance. Aetna has over 22 million members and receives annual revenues of over $60 billion. With revenue over 50 billion and membership over 14 million, Humana ranks number five of all U.S. health insurers.
Is Aetna better health a Medicare Advantage plan?
Aetna® offers many Medicare Advantage Dual Eligible Special Needs plans (D-SNP) to people on Medicare who are also eligible for Medicaid. A HMO is a health maintenance organization that requires you to use network providers for covered services.
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.
What will happen to Medicare Advantage plans in 2025?
Medicare Advantage Highlights for 2025
Nearly one-third (32%) of Medicare Advantage plans will offer some reduction in the Medicare Part B premium in 2025, an increase compared to 2024 (19%). Nearly all Medicare Advantage plans (97% or more) are offering vision, dental and hearing, as they have in previous years.
Do I have to renew my Aetna Medicare Advantage plan?
In most cases your coverage will auto-renew each year. You don't have to do anything to continue with your current plan. But if you'd like to make changes, you'll get the chance to do so during the Annual Enrollment Period.
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.
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.
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.
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 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 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.
Why are people losing Medicare Advantage?
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 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.