The Hidden Risks of Medicare Advantage You’re Not Hearing About
⚠️ Important Resources: What You Need to Know About Medicare Advantage (MAPD) Problems
Below are reports and news stories from reliable sources showing the growing issues with Medicare Advantage Plans – from denied care and disappearing networks to hospitals refusing coverage.
Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds (New York Times) — A federal inspector general report found that MA plans frequently reject prior-authorization and payment requests that actually meet Medicare’s coverage rules, delaying or denying Medically necessary care.
Medicare Advantage Enrollees Have Access to About Half of the Physicians Available to Traditional Medicare Beneficiaries (KFF) — In 2022, MA enrollees had access to only 48% of the physicians available under traditional Medicare in their area, highlighting how restricted provider networks are a major tradeoff of Medicare Advantage coverage.
How Medicare Advantage Scams Seniors (Newsweek) — Insurers aggressively market “zero co-pay” MA plans to seniors, but many have limited networks and strict Prior authorization rules, leaving retirees exposed to coverage denials and high out-of-pocket costs.
It’s Time to End the Medicare Advantage Scam (The Nation) — The article argues that “Medicare Advantage” is misleading branding for private insurers who profit by denying care and restricting networks, and calls for Congress to stop allowing them to use the word “Medicare.”
Prior Authorization Denials Up Big in Medicare Advantage -The share of prior authorizations denied (or partially denied) rose compared to earlier years. The increase is both in volume and in the types of services affected.
Hospitals and doctors are fed up with Medicare Advantage (Washington Post) — Talks about growing friction: Claim denials, onerous prior authorization requirements, hospitals and physician practices refusing to accept some MA plans even from big insurers.
Medicare Advantage Increasingly Popular With Seniors — But Not Hospitals and Doctors (KFF Health News) — providers complaining about payment rates, denials, authorization burdens. Also notes that many hospitals / provider systems are refusing some MA plans even as Medicare Advantage enrollment rises.
Iowa Specialty Hospital to stop accepting certain Medicare Advantage plans — The hospital is stopping some MA plans because of frequent delays, denials, slow reimbursements.
Danbury Hospital sues health insurance giant for repeatedly failing to pay Medicare Advantage claims — Danbury Hospital (Connecticut) sues UnitedHealthcare for underpaying and breaching contract under their facility agreement.
Unacceptable: Nebraska Hospital Association speaks out about Medicare Advantage plans — Hospitals in Nebraska saying that MA plans cover more people but that enrollees may pay more; also many providers are not contracting with some MA plans, experiencing delays, denials.
Medicare Advantage coverage denials raise health care access concerns — A report by the HHS Office of Inspector General found that some denials by Medicare Advantage organizations met Medicare coverage rules (i.e. were improper denials), leading to delays, extra steps, burden.
Medicare Advantage is a disadvantage (VTDigger) — Argues that MA plans restrict access through narrow networks, create surprise billing risks, and prioritize insurer profits over patient needs.
She dumped Medicare Advantage; still healthy, she went to traditional Medicare & affordable Medi (Daily Kos) — A personal account of leaving MA for traditional Medicare due to better access and fewer barriers to care.
New Hampshire official warns Medicare Advantage market is ‘collapsing’ (Becker’s Payer) — The state insurance commissioner warns that insurer exits are severely shrinking MA plan choices for seniors.
Medicare Advantage Plans Denied 2 Million Prior Authorization Requests in 2021(KFF) — A review finding that MA plans denied roughly 6% of prior-auth requests.
Thousands of Maryland seniors notified of the end of their Medicare Advantage plans (Maryland Matters) — More than 100,000 enrollees must switch plans after major insurers exit the state’s MA market.
Medicare Advantage Plans Denied a Larger Share of Prior Authorization Requests in 2022 Than in Prior Years (KFF) — Denial rates rose to 7.4% in 2022, with most appealed denials reversed.
Why Johns Hopkins Refused to Let an Insurance Giant Decide Your Treatment (Johns Hopkins Medicine) — Explains why Johns Hopkins cut ties with UnitedHealthcare over excessive denials and burdensome authorization requirements.
Health Tracking Poll: Public Finds Prior Authorization Process Difficult to Manage (KFF) — Despite insurers’ pledge to ease prior authorization burdens, the poll shows most people still experience delays and denials as a major problem, and very few are even aware that insurers made such a pledge.
Michael Quinn is a seasoned Medicare insurance expert and licensed agent dedicated to simplifying the complexities of healthcare coverage. With over a decade of experience, he is a trusted advisor known for his compassionate guidance and commitment to empowering individuals. As the Cofounder of REMEDIGAP in 2013, Michael offers unbiased resources and personalized support to assist clients in making informed decisions.
His expertise has been recognized on reputable platforms such as USA Today and Nerdwallet, solidifying his reputation as a reliable and knowledgeable industry leader. With a Master's Degree in Communicative Disorders, Michael combines strong communication skills with a genuine passion for positively impacting lives through tailored insurance solutions.
Written by Michael Quinn
Licensed Broker, REMEDIGAP Founder
Fact Checked by Joann Quinn
Chief Compliance Officer
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