Why Are Hospitals Dropping Medicare Advantage Insurance Plans?

Reading Time: 4 minutes


Recently Kevin Price, Host of the nationally syndicated Price of Business Show, interviewed Dr. David Wilcox.

Health Transparency: The Real Truth with Dr. David Wilcox 

Medicare Advantage provides health coverage to more than half of the nation’s seniors, but a growing number of hospitals and health systems nationwide are dropping some or all contracts with the private plans altogether.

Among the most common reasons are excessive prior authorization denial rates and slow payments from insurers. Some systems have noted that most Medicare Advantage insurers have faced allegations of billing fraud from the government and are being probed by lawmakers over their high denial rates.

Recently on Capitol Hill a bipartisan group of lawmakers became increasingly concerned that insurance companies are preying on seniors, and, in some cases, denying care that would otherwise be approved by traditional Medicare.

These are the same lawmakers who helped create Medicare Advantage programs through the passing of the Balanced Budget Act in 1997 and further tweaked the program to cover prescription medications in 2003 when they decided to privatize Medicare. Now 20 years later the Medicare Advantage insurers are acting, well…like insurance companies, which is what they are.

The way Medicare Advantage works is they take money from the government’s Medicare program to fund the care you receive. They often up code, or charge more for your care to drive up profits, hence the billing fraud concern. After all, they have to pay their Chief Executive Officers and other executives salaries. Salaries that can reach up to and exceed 21 million dollars a year!

San Diego based Scripps Health is facing a loss of $75 million this year on the Medicare Advantage contracts, which will end Dec. 31 for patients covered by UnitedHealthcare, Anthem Blue Cross, Blue Shield of California, Centene’s Health Net, and a few smaller carriers.

This impacts plan participants who now have to find care at alternative facilities. Some have to drive miles out of their way to find a health system that will accept their Medicare Advantage plan. This can become a nightmare for the insured individuals who in good faith, trust their Medicare Advantage plans to pay for the care they receive.

While there is some action being taken on Capital Hill, legislation requiring insurers to quickly approve requests for routine care passed unanimously in the House in 2022 but stalled in the Senate over cost concerns. With the amount of money that the insurance companies spend lobbying our nation’s lawmakers, I wouldn’t hold my breath that they will be able to stop the monster they helped create.

So what can you, as an informed healthcare consumer, do to avoid being a victim of the aggressive Medicare Advantage machine? If you are approaching 65 years of age get ready for the onslaught of insurers peddling Medicare Advantage programs that will be coming your way. If you sign up for traditional Medicare you will be given the option to purchase Medigap insurance to cover the 20 percent that Medicare doesn’t pay as Medicare only pays for 80 percent of your healthcare coverage. This Medigap insurance will be provided by an insurance company. The biggest difference between Medigap and Medicare Advantage is that with a Medigap plan, you have the freedom to see any doctor that accepts Medicare, whereas, with Medicare Advantage, you must get care within the plan’s network of doctors and hospitals unless it’s an urgent or emergency situation. You can also add a separate Medicare drug plan to get Medicare drug coverage (Part D).

In traditional Medicare, no payer or insurance company will ever get in the way of you and your doctor. You will have the freedom to obtain care at any health system or doctor’s office that accepts Medicare. This approach guarantees you won’t have an insurance company dictating what healthcare you are allowed to receive. In my opinion, this is a much better option. Hopefully, when your time comes to enroll in Medicare you will be informed enough to make the decision that is best for your situation.


You can purchase Dr. David Wilcox’s book How to Avoid Being a Victim of the American Healthcare System: A Patient’s Handbook for Survival on Amazon at the following link https://lnkd.in/diZKYC2

Follow me on social media at:

Facebook – https://www.facebook.com/Dr-David-Wilcox-102834559130574

Twitter – https://twitter.com/DrDavidHelps

You Tube – https://www.youtube.com/channel/UCyYHs6ttrJ5l6-kUc-lEP9Q


According to a statement, “Healthcare is complex and that is not an accident. It is complex by the healthcare entities vying for your healthcare dollars. Covid has exacerbated the American Healthcare System, which was fragile, to begin with. Many clinicians are leaving healthcare due to burnout. How does the average layperson navigate the complexities of the American Healthcare System where a prescription could cost you $5 at one pharmacy and $500 at another? What does the average layperson do when their insurance company rejects their claim? Proactive education of the American Healthcare System prior to accessing it is the key to safely navigating the healthcare system. Until now, little information has been available to provide the layperson with the knowledge they need to be a better partner in their health care. Dr. David Wilcox’s book How to Avoid Being a Victim of the American Healthcare System: A Patient’s Handbook for Survival” is a game-changer and will provide you with the skill set you need to navigate the American Healthcare System.

Website: https://drdavidwilcox.com/

Dr. Wilcox is a Doctorate prepared nurse who also holds a Masters in Health Administration and is Board Certified in Nursing Informatics. Dr. Wilcox has 28 years of healthcare experience in which he worked as a bedside nurse, hospital administrator, and in healthcare information technology which has helped him to develop his unique perspective on the American Healthcare System.

Dr. Wilcox is the author of the book “How to Avoid Being a Victim of the American Healthcare System: A Patient’s Handbook for Survival (2021)” available at https://www.amazon.com/dp/0578878364

Dr. Wilcox currently resides in North Carolina with his wife and their three dogs.

Dr Wilcox’s website: Dr. David Wilcox – Healthcare, American Healthcare System (drdavidwilcox.com)



Share This:

Leave a Reply

The reCAPTCHA verification period has expired. Please reload the page.