Untitled (8.5 x 3.75 in) (8.5 x 4 in) (1).jpg

Navigating Medicare Advantage Plans and Hospital Rejections

According to the Centers for Medicare & Medicaid Services, Medicare Advantage is a type of Medicare Health Plan "offered by Medicare-approved private companies that must follow rules set by Medicare." Most Medicare Advantage Plans include drug coverage (Part D). Https://www.medpagetoday.com/ states that more than half of all Medicare Beneficiaries are enrolled in Medicare Advantage.

Recently, hospitals have been rejecting Medicare Advantage plans because the carriers who offer these coverages are providing inadequate payments that don't cover the cost of patient care.

Medical facilities, including Scripps' Health, which is one of San Diego's top Medical Centers' have experienced a loss of $75 million this year solely on the Medical Advantage contracts. In late September of 2023, Scripps announced that they were terminating Medicare Advantage contracts, as reported by Becker's Hospital Review, which would affect more than 30,000 estimated seniors regionally; doctors from Scripps Clinic and Scripps Coastal will still accept Original Medicare (Part A and Part B). Doctors who are part of an independent medical group affiliated with Scripps can still allow their Medicare Advantage patients to receive care.

Nonetheless, these substantial changes complicate seniors' coverage by their physicians. Hospitals are undergoing a cumbersome situation as they need to fund their staff, doctors, nurses, and facilities to function properly. Situations that could affect these cancellations (creating delayed payments to hospitals), are low premiums from Insurance Companies, independent agents' busy schedules, and seniors not following through with their Health Plans. Medicare Advantage cancellations have become a trend in multiple centers throughout Southern California and are happening nationwide.

It is critical to be knowledgeable of which centers and practitioners accept MA coverage. The future of Medicare Advantage plans remains unclear as the current relationship between Insurance Providers that have this Health Plan and Hospitals remains tumultuous.