33 Hospital Systems Leaving Medicare Advantage Networks Amid Cost and Authorization Issues

Thirty-three hospital systems are exiting their Medicare Advantage contracts, increasing the number of hospitals becoming out-of-network for MA plans. Major hospitals like Mayo Clinic, Vanderbilt Health, and Mass General Brigham are among those discontinuing participation. The primary reasons cited include high prior authorization denial rates and delayed insurer payments, impacting hospital participation in MA networks. Medicare Advantage enrollees generally benefit from lower out-of-pocket costs compared to traditional fee-for-service Medicare. MA plans, managed by private companies, tend to enforce more rigorous cost controls on hospital charges, which can create tension with hospital systems. This dynamic aims to enhance spending efficiency and reduce taxpayer burdens. Debate continues over offering Medicare enrollees more affordable choices, including proposals for medical indemnity insurance and options to exit Medicare without penalties. These discussions highlight ongoing challenges in balancing cost management, hospital network participation, and patient insurance affordability within the Medicare landscape.