Hospitals are increasingly refusing or dropping Medicare Advantage (MA) plans due to unsustainable administrative burdens, including high rates of denied care authorizations, delayed payments, and lower reimbursement rates compared to traditional Medicare. These issues, often described as a "delay, deny, or don't pay" model, have caused significant financial losses and care delays, prompting major health systems to exit networks.
These providers are called "non-participating." If your doctor, provider, or supplier doesn't accept assignment: You might have to pay the full amount at the time of service. They should submit a claim to Medicare for any Medicare-covered services they give you, and they can't charge you for submitting a claim.
CVS Health, Humana, and UnitedHealth Group have announced that they will pull back on Medicare Advantage (MA) and Part D prescription drug plans next year. These changes are a response to financial pressures, including changes to government funding and rising healthcare costs.
Key Findings: Medicare Advantage enrollees were in a plan that included just under half (48%) of all physicians available to traditional Medicare beneficiaries in their area in 2022, on average.
If you joined a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without a drug plan) within the first 3 months you have Medicare Part A & Part B.
Many major health systems are dropping or limiting Medicare Advantage (MA) contracts, especially with UnitedHealthcare (UHC) and Humana, due to low reimbursement rates and high claim denial rates, with prominent examples including Mayo Clinic, Johns Hopkins, Mass General Brigham, Providence, UNC Health, and Sutter Health, impacting many states as they exit networks in 2025 and 2026 for various MA plans.
Medicare Advantage plans are difficult to budget, and most plans have high out-of-pocket costs. This is the biggest reason they are bad for some people. With Original Medicare and supplemental Medicare insurance, you pay the bulk of your major medical costs upfront through monthly insurance premiums.
Medicare Advantage Plans are being pushed so hard because they offer additional benefits beyond what original medicare provides. These plans are offered by private insurance companies and can often include prescription drug coverage and extra services such as dental, vision, and hearing.
Medicare Advantage plans are structured around provider networks. Your ability to keep your doctor largely depends on whether they participate in your plan's network. Most plans utilize Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) models.
Medicare Advantage plans pay physicians an estimated 10% to 15% less than what is paid by the government in traditional Medicare, according to the 2025 Omniscient Health Physician Medicare Income Report.
Simply put, a growing majority of seniors choose MA because it provides better and more coordinated care, more comprehensive benefits, better outcomes and increased savings and financial security compared to FFS Medicare. For most Medicare-eligible patients, these advantages are available for no additional premium.
Starting in 2025, there is an annual limit on what you pay out-of-pocket for prescription medications through Medicare and Medicare Advantage prescription drug plans. All prescription medications, including specialty medications, covered by Part D plans are included under this cap.
An AARP Research study of Medicare Advantage beneficiaries 66 and older shows high satisfaction rates among those who identify themselves as being in very good or excellent health — although those who self-identify as being in poor or fair health express less satisfaction with their plan.
Medicare Advantage provides enrollees with coverage exceeding that offered under Traditional Medicare coverage. In theory, these MA plans are meant to increase enrollee choice and access to necessary health services and to reduce costs for the government.
The final rule revises the current Part D quarterly special enrollment period (SEP) for dually eligible, and other Part D low-income subsidy enrolled individuals, to a once-per-month SEP to enroll in a standalone prescription drug plan and creates a new integrated care SEP to allow dually eligible individuals to elect ...
If your MA plan stops providing benefits in your area at the end of the year, you have the right — regardless of age or health condition — to join another MA plan if one is available where you live, or to return to Original Medicare and join a Part D plan.
The extra $144 added to Social Security usually comes from the Medicare Part B Giveback benefit, offered by some Medicare Advantage (Part C) plans, which pays back some or all your Part B premium, showing up as extra money in your check if it's deducted from your Social Security. To qualify, you need Original Medicare (Parts A & B), pay your own Part B premium, live in a plan's service area, and enroll in a specific Medicare Advantage plan that offers this "rebate," with the amount varying by plan and location.