Growing Criticism of Medicare Advantage Administration

Medicare Advantage now accounts for over 55% of the Medicare population, but it's facing significant criticism from health systems due to issues like prior authorization denials and slow payment processes. These administrative hurdles have led to a growing number of health systems terminating their contracts with Medicare Advantage plans. In 2024, contract disputes between payers and providers peaked, with a striking 64% of these disputes involving Medicare Advantage plans.

Rick Pollack, CEO of the American Hospital Association, highlighted the attractiveness of Medicare Advantage benefits for beneficiaries; however, this appeal diminishes when they encounter bureaucratic obstacles. Between 2022 and 2023, denials of claims for Medicare Advantage plans surged by an alarming 55%. Pollack suggests that enhancing cooperation between healthcare providers and insurers is crucial for improving the situation, emphasizing the need for partnerships that promote better management of care and shared savings arrangements.