Medicare Advantage Plans Face Criticism Over Care Delays and Hospital Participation

Medicare beneficiaries face an annual decision between traditional Medicare and Medicare Advantage plans, with the deadline for enrollment recently passed. Medicare Advantage plans, managed by private insurers under government contracts, are popular due to low premiums and added benefits like dental and vision coverage but often include provider networks, copays, and prior authorization requirements that can delay care. Hospitals like Great Plains Health in Nebraska report excessive claim denials and administrative burdens from Medicare Advantage plans, leading some to stop accepting certain plans altogether. This trend is not isolated, as dozens of health systems nationwide have dropped Medicare Advantage plans due to payment disputes and costly administrative processes. The Medicare Payment Advisory Commission notes the federal government pays substantial monthly fees to these private plan providers, contributing to increased Medicare expenditures. Advocates for Medicare Advantage highlight industry commitments to improve claim processing times, while bipartisan legislative efforts aim to enhance transparency in the program to better inform senior enrollees. These developments illustrate ongoing challenges in balancing cost, access, and administrative efficiency within Medicare's evolving landscape.