Why are hospitals not taking Medicare Advantage plans?

Question

Don Golding · Accepted Answer

Hospitals negotiate with insurance companies and plans for payments. Depending on the plan's payment structure, a hospital (or any care provider) makes a business decision to accept the plan(s). Hospitals generally sign multi-year agreements with the insurance carriers.

Answered by Don Golding on April 28, 2025

Broker Licensed in TX, AL, AR & 5 other states

Answered by Don Golding Medicare Insurance Agent

Gary Church · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/why-are-hospitals-not-taking-medicare-advantage-plans#gary-church

Norman Smith · Answer

Doctors, Specialists, hospitals are not paid as much by the private practices, not are they paid as fast as they are from Original Medicare. Makes you stop and wonder what is the difference in the care you then get from those that will accept it. These are the reasons facilities like Moffett, Mayo, The Cleveland Clinic, John’s Hopkins, etc. will not take it. If the best won’t accept it, why are you settling in YOUR health needs?!?!

Answered by Norman Smith on November 29, 2025

Agent Licensed in FL, AL, NJ & PA

Answered by Norman Smith Medicare Insurance Agent

William Lawler · Answer

Hello Bill, Lawler here. The question is, why are hospitals not taking Medicare Advantage plans? Well, they are taking Medicare Advantage plans, but they do not take all Medicare Advantage plans. Check and make sure before you enroll in a Medicare Advantage plan that the doctor and the hospital you prefer accept that plan. I'm here to help.

George Ibanez · Answer

Hospitals are increasingly dropping Medicare Advantage plans due to excessive administrative burdens, prior authorization denials, and slow payments to the hospitals by the Medicare Advantage insurance companies.
For information on switching to a Medicare supplement plan, contact George.

Voss Speros · Answer

Voss Speros here, Greek god of Medicare, talking about Medicare today. Got a question: how come hospitals are starting to not take Advantage plans in different places? So it depends on the hospital, the state, the county, and the Advantage plan. Some say it's the administration costs, getting procedures done, authorization. A lot of it boils down to reimbursement rate. The hospital wants a certain reimbursement rate, while the insurance companies have an average reimbursement rate for hospitals across the country. Then they try to discuss and contract with the hospital and the insurance companies. If the hospital says, "I don't want it," it's based around the reimbursement rate that the insurance companies are going to give them.

Everybody likes original Medicare and Medicare supplement because there are no contracts for that; they just bill it. On the Advantage side, the providers, the hospital has to contract with the carrier to accept that insurance. Sometimes they just can't come to terms on it, and then a hospital chain doesn't take it. So hospitals don't take all carriers. They take a handful, the ones they can contract with, come to the tables, work out an agreement, and then do that.

So when you're looking for hospitals in your plans, make sure the one you go to is in the carrier, so you don't have to go to a different hospital. If you have any questions, give us a call.

Pamela Masters · Answer

Hospitals contract with each hospital and if the company and the hospital can’t come to an agreement at renewal time then they are not in network. I don’t know about them not filing but that at least is one reason

Answered by Pamela Masters on October 9, 2025

Broker Licensed in NC

Answered by Pamela Masters Medicare Insurance Agent

Charise Karjala · Answer

This is a thorny question: why are hospitals not taking Medicare Advantage plans? The flat-out answer is that they can't afford to. Medicare Advantage, when they negotiate with the independent physician's associations, they are negotiating for 50% of the Medicare fee schedule or lower. So if Medicare pays, let's just say they pay $10,000 a day for whatever it is for the hospital to accept reimbursement under the Independent Physicians Association contracted rates, they might be having to accept $4,000 or $3,000 a day. And they can't meet their requirements for staffing, for safety, for facilities, for management, for cleanliness. They just can't do it. It's a rough place to be.

So we need to be careful, especially seniors that are moving outside of a given area because they want to go somewhere where there's less expensive real estate. I see people leaving from California to Arizona or to Nevada or elsewhere into these outlying areas, and there are no plans for them. The hospitals are small; they can't afford to accept the plans. They don't have economies of scale.

So that's the reason why hospitals aren't taking Medicare Advantage plans: we've discounted the fee schedule so much, not only for doctors who have been taking 2.5% cuts year after year after year after year, but the facilities as well. So we need to be mindful that we can only go so far with cuts before we're cutting access to care. And access to care is something that is legally guaranteed as a right for every one of us. And we're shooting ourselves in our own foot. So we need to have a good look-see at what we're creating here. Different communities have different resources. So we need to think about this very carefully.

Paul Potter · Answer

In our area, most if not all hospitals accept Medicare Advantage Plans.  It is easier for hospitals to play hard ball with insurance companies than with the Federal Government so I believe that is a big reason.

You should always make sure your advantage plan includes your doctors, hospitals and drugs before selecting that plan.   If you want help, you can contact me directly.

Paul Potter

Sandy Johnson · Answer

While all Medicare Advantage Plans may not be accepted at certain hospitals, there are many hospitals that do accept Medicare Advantage Plans. It's always a good idea to have an agent who can research this information for you and place you in a plan that covers your referred locations.

Answered by Sandy Johnson on May 22, 2025

Broker Licensed in LA, AL, AR & 11 other states

Answered by Sandy Johnson Medicare Insurance Agent

Nicholas Depke · Answer

Some hospitals and health systems have been dropping Medicare Advantage plans or refusing to contract with certain carriers because the reimbursement rates insurers pay are often lower than what Medicare pays directly, and the prior authorization requirements have become a serious burden on their staff and patients. When a hospital spends significant time and resources fighting insurance companies for approvals on procedures that should be straightforward, it affects their ability to operate efficiently and gets in the way of patient care. This does not mean all hospitals are leaving all Medicare Advantage plans, but it is a real and growing trend worth paying attention to. If you are on a Medicare Advantage plan or considering one, it is smart to verify every year that your preferred hospitals and specialists are still in network, because networks can change on January 1st even if you stay on the same plan.

Answered by Nicholas Depke on March 26, 2026

Broker Licensed in NE, AZ, FL & 15 other states

Answered by Nicholas Depke Medicare Insurance Agent

Mitchell Jerome · Answer

I don't think that's an accurate statement. I live in Houston, 4th largest city, and Advantage plans are accepted by the hospitals. They definitely don't take every plan but they do have networks that are Medicare compatible. Main reason insurance co's and hospitals would have a riff is money; can't find an acceptable remuneration rate between them.

Answered by Mitchell Jerome on February 17, 2026

Broker Licensed in TX

Answered by Mitchell Jerome Medicare Insurance Agent

Rodney Turner · Answer

Hospitals may not accept Medicare Advantage plans for a few reasons. One key factor is contracting—Medicare Advantage plans are offered by private insurance companies, and hospitals need to sign agreements with these insurers. Some hospitals may not reach an agreement due to low reimbursement rates or differences in contract terms. Additionally, certain regional networks or specific hospital systems might not participate in the networks of some Medicare Advantage plans. This can limit your options if you're enrolled in a particular plan.

Answered by Rodney Turner on March 3, 2026

Broker Licensed in FL, AL, AR & 27 other states

Answered by Rodney Turner Medicare Insurance Agent

Kirk Hale · Answer

It could be because of several reasons. The hospital is not in network, the hospital doesn't have a contract with the insurance company selling the advantage plan, the hospital doesn't like the payment amounts they are getting from the insurance company. Some insurance companies pay slower than others. You might consider staying with Original Medicare and buying a supplemental plan instead of joining an Advantage plan to avoid some of these issues.

Answered by Kirk Hale on May 7, 2025

Broker Licensed in MS, AL, AR & 27 other states

Answered by Kirk Hale Medicare Insurance Agent

Steven Bleicher · Answer

This is not true. Only the specialty hospitals like the Mayo Clinic’s, Sloan- Kettering in NYC, the Cleveland Clinic, MD Anderson in Houston, the Cancer Centers of America, etc. won’t accept a MAPD as those plans for the most part don’t pay in a timely manner while a Supplement company will pay sooner. All other hospitals will take the Advantage plans. Your company’s “Summary of Benefits” booklet will enumerate the accepted local hospitals, along with your own agent/broker.

Answered by Steven Bleicher on August 2, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Steve Houchens · Answer

Hospitals do accept Medicare Advantage although they can pick and choice which plans they accept to be in network for. Its always important when picking a plan to make sure if the hospital you would want to use accepts the plan you are looking at. They are not obligated to take every plan offered excepted in an emergency situations.

Answered by Steve Houchens on July 9, 2025

Agent Licensed in KY & TN

Answered by Steve Houchens Medicare Insurance Agent

Robert Baez · Answer

Hospitals and health care centers are contracted with carriers and depending on the situation may not renew their contract. You should check with your insurance carrier or medical center to see if they are contracted with your insurance carrier.

Answered by Robert Baez on April 11, 2025

Agent Licensed in IL, AZ, FL, OH & TX

Answered by Robert Baez Medicare Insurance Agent

Marnie Applegate · Answer

Hi, this is Marnie Applegate, a Medicare agent for you, and I am here answering a question about why hospitals are not taking Medicare Advantage plans. There are several hospitals around the country, and at the beginning of 2025, I think the number was at 27 that actually stopped taking Medicare Advantage plans. That could be due to financial strain from lower reimbursement rates from the carriers. Some of the carriers are slower to pay, and some carriers have denials or extensive prior authorization processes. So that is causing some hospitals to no longer take Medicare Advantage plans.

Open enrollment, or annual enrollment, goes from October 15th to December 7th. So if you currently have a plan and a hospital that is no longer in-network, now is the time for you to make a change. Also, don't forget about the Medicare Advantage open enrollment period, which runs from January 1st through March 31st. That's also another opportunity for you to make a change should your hospital decide to no longer accept the Medicare Advantage plan that you're currently on. Thanks, and have a great day!

Ami Fouts · Answer

I am not seeing this issue in our area. Some plan may not be contracted out of state, but generally we find most Medicare Advantage plans are accepted wherever Medicare is accepted.

Gary Henderson · Answer

That is a contractual issue between the hospital and the insurance carrier. If they're not taking a Medicare advantage plan, they have their reasons for it. Typically if you stay with major brands you don't have that problem. It's when you get these small off-brand companies that are the ones that tend to Make it harder to find in-network hospitals 
Get a Medicaid plan. You don't have to worry about any of that because because you're on regional Medicare and your Medicaid plan just pays the difference. If they take original Medicare they must take your Medicare supplement or medigap plan

Andrew Kramer · Answer

I have not come across that issue. Perhaps some hospitals in some counties are not taking some specific plans anymore for a planned surgery. But anyone on any Advantage plan can go to the ER of any hospital in the US and receive care, and be admitted, if needed, on their plan.

Answered by Andrew Kramer on May 16, 2025

Agent Licensed in FL

Answered by Andrew Kramer Medicare Insurance Agent

Meghan Blankenship · Answer

Hospitals are increasingly dropping Medicare Advantage plans due to excessive administrative burdens, prior authorization denials, and slow payments to the hospitals by the Medicare Advantage insurance companies.

For information on switching to a Medicare supplement plan, contact George.

Carol Thompson · Answer

Hospital are still taking Medicare Advantage plans. CMS and insurance carriers have contracts they have government contracts.

Jack Mayer · Answer

Each year the insurance carriers that offer Medicare Advantage Plans re-negotiate contracts with providers and hospitals under CMS rulings and if the deadline is not met for one reason or another, it is possible to lose those providers and hospitals. I have some information and can expand on that if interested. The main thing is to go with a flagship carrier that has huge networks such as United Healthcare for example. Just a note of confidence, 9 our of 10 people stay with UHC once they enroll.

Answered by Jack Mayer on April 12, 2025

Agent Licensed in CA & NV

Answered by Jack Mayer Medicare Insurance Agent

Jennifer Kalbach · Answer

Hospitals can chose what carriers they want to contract with. I do not think it is a case if they are taking MA or not rather are they contracted with the carrier. These are for profit organizations.

Answered by Jennifer Kalbach on March 30, 2026

Agent Licensed in KY

Answered by Jennifer Kalbach Medicare Insurance Agent

Pat Papson · Answer

Good Morning

Each hospital and Dr's have a choice what plans they choose to accept.

The best option is to check which facilities take your plan..

Karen Ansell · Answer

Some hospitals are not taking Medicare Advantage plans. Because of prior authorizations leading to higher administrative costs and reimbursements taking so long.

Jaye Maxx Alexander II · Answer

That is a false statement and a rumor. Hositals that take Medicare Part A and will accept MAPD plan.

Don Hansford · Answer

Medicare and health insurance in general seems to get more complicated year after year. The majority of time when this occurs, it is strictly a financial issue. What the hospitals receive is much lower under Medicare vs Commercial plans, and on top of that each insurance carrier negotiates their contracts with the hospital systems. If they get to the point that they don’t feel their compensation is sufficient, they will leave the network.

Answered by Don Hansford on October 4, 2025

Broker Licensed in TX

Answered by Don Hansford Medicare Insurance Agent

Mel Stevens · Answer

Why are hospitals not taking Medicare Advantage plans? In general, the majority of hospitals do take Medicare Advantage plans, especially during an emergency. There are some instances for example, The Mayo in general only accepts recipients with a Medicare Supplement vs recipient with a Medicare Advantage policy. Again, the majority of hospitals with accept Medicare Advantage insurance. That being said some Insurance providers and Insurance policies have larger networks than others.

Answered by Mel Stevens on May 12, 2025

Broker Licensed in AZ

Answered by Mel Stevens Medicare Insurance Agent

Charles Borg · Answer

Usually Because they’re not in the Advantge plans network. There are many reasons for that so no one Answer can cover all the reasons.

Dominic Javier · Answer

Medicare plans that have Coordinated Care Plans have a network of preferred providers such as Health Maintenace Organization (HMO), Preferred Provider Organization (PPO) and Private Fee for Service (PFS). Check well if the area of coverage of your plan covers your home area.

Answered by Dominic Javier on April 15, 2025

Broker Licensed in TX

Answered by Dominic Javier Medicare Insurance Agent

Earl Beck · Answer

Hospitals take Medicare Advantage pjans. It all depends on what network you Hospital is in and what area of coverage your MA plan covers.

Peggy Elliott · Answer

Yes, hello. I'm a licensed health and life insurance agent, and I work primarily with United HealthCare and Medicare Advantage plans. I have close to 500 clients who have been covered with them for years. I don't have anyone calling me telling me that hospitals are not accepting their plans. It seems to be very competent plans that help people. Thank you very much.

William Wheatley · Answer

The short answer is a higher rate of denied claims,slow reimbursement, and extensive prior authorization requirements for treatments by private insurers. This is more costly for hospitals and lees profitable. The real truth is both parties share blame as Hospitals charge above normal charges for procedures insurance companies work for profit and limiting price over charges from one hospital to another and physician charges is in best interests for all. Think ofbit this way if a hospital charges $50 for a pill 💊 like Tylenol but another facility only charges 10 isn't it in best interests to try to stop that excessive charge for all parties? Most don't want to hear it but it is important that a Medicare Advantage or Medicare patient it the best quality care and the cost be national average not a reason to be greedy!

Answered by William Wheatley on October 17, 2025

Agent Licensed in MD

Answered by William Wheatley Medicare Insurance Agent

Daniel Underwood · Answer

Some hospitals are not taking Medicare Advantage plans. Because of prior authorizations leading to higher administrative costs and reimbursements taking so long.

Answered by Karen Ansell on April 22, 2025

Agent Licensed in FL, GA, KY & OH

Answered by Karen Ansell Medicare Insurance Agent

Christopher Akers · Answer

Financial concerns. They can have lower reimbursement rates compared to traditional Medicare, delayed payments and possibly administrative burdens. MA plans can be more restrictive with more claim denials and possibly require prior authorizations for many services. This can increase administrative costs, and cause delays or denials.

Answered by Christopher Akers on October 14, 2025

Agent Licensed in TN, FL, OH & VA

Answered by Christopher Akers Medicare Insurance Agent

Velvet Ohlen · Answer

Great question. Every hospital negotiates with the healthcare companies to be under contract or in network. If a hospital is in network that can help the Medicare Advantage beneficiaries with in network savings.  
If the hospital and health insurance plan cannot agree on cost, fees and pay, the hospital will opt out of the relationship with the health insurance plan. This results to hospital not taking the Medicare Advantage healthcare plans.

Steven Rodriguez Giudicelli · Answer

Some hospitals choose not to accept Medicare Advantage plans due to lower reimbursement rates compared to Original Medicare, and the administrative complexities associated with different private insurance plans. Additionally, network restrictions inherent in Medicare Advantage plans may lead some hospitals to opt out of certain contracts.

Answered by Steven Rodriguez Giudicelli on June 3, 2025

Broker Licensed in FL & TX

Answered by Steven Rodriguez Giudicelli Medicare Insurance Agent

Darnel Brown · Answer

Not all hospitals deny Medicare Advantage plans. It is very important before signing up for your Advantage plans to make sure your doctors 
As well as hospitals are in network. In emergency all hospitals by law have to accept you. This is an exception

Chris Prang · Answer

Hey, well, I got a question, and it's not the first time I've gotten the question. And I'm sure it will not be the last time I've gotten the question. The question is, why are hospitals not accepting the Medicare Advantage plans?

So first, the vast majority of hospital systems do accept Medicare Advantage plans. Now, they don't accept them all for sure, but the vast majority do accept some of the Medicare Advantage plans. And actually, there are a number of hospital systems that have their very own Medicare Advantage plan.

But the main reasons why are, number one, how much they are getting reimbursed by the Medicare Advantage plan company. So that would be number one. Number two, a little bit even more critical, are the hoops that they have to jump through to get reimbursed from the Medicare Advantage plan. And then probably number three would be like the prior authorizations that the hospital systems and the providers have to deal with. Providers can end up taking a lot of their time that they're probably not getting reimbursed for to submit prior authorizations and wait for those things to come back before they can receive treatment for one of their patients. And it's just gotten overwhelming for a number of hospital systems.

Many of them are actually losing money on some of the Medicare Advantage plans that they are dealing with. So their only solution, unfortunately, is to just drop the Medicare Advantage plan company that they are dealing with, whether it's one or more.

Now, what happens a number of times is the hospital system that has a contract with the Medicare Advantage plan to be a network. What they will do to get more money is they will threaten to leave the network, or they actually will leave the network, and they will use it as a bargaining chip to get more money from the Medicare Advantage plan company.

So that is why, and I will maybe even try to provide some links in this video, but there are a lot of hospital systems that have pulled out of a lot of Medicare Advantage plan networks. And so if you have a Medicare Advantage plan, you must always check to make sure your provider is in the network, especially on an annual basis. Unfortunately, the provider can leave anytime they want in the middle of the year.

So that is why the hospital systems are not accepting or they are dropping out of the Medicare Advantage plan networks. I hope that helps some people. If you need help with your Medicare Advantage, don't hesitate to reach out to me.

Lesley Paul · Answer

While some hospitals say that the payment rates offered by some Advantage plans are sometimes too low, or have other requirements that slow the reimbursement process, they solve these disputes within the contract negotiation period.

Answered by Lesley Paul on December 2, 2025

Agent Licensed in FL

Answered by Lesley Paul Medicare Insurance Agent

Josefina Escobar · Answer

Hospitals often drop Medicare Advantage plans because they feel the payment rates are too low and the plans require more paperwork, prior authorizations, and claim reviews. From the Medicare Advantage side, plans have fixed budgets from the government and may exclude hospitals that are too expensive or won’t agree to their cost‑control rules. As a result, both sides walk away when they can’t agree, and patients can lose access in the middle.

Answered by Josefina Escobar on April 14, 2026

Broker Licensed in NC

Answered by Josefina Escobar Medicare Insurance Agent

David Cranford · Answer

Hospitals will contract directly with Medicare as will doctors. Insurance companies who sell Medicare Advantage agree to administer your Medicare benefits. This requires each Medicare Advantage companies to contract with the hospitals and doctors and agree on reimbursement amounts. When disagreements arise on the amount of reimbursement for service then the contract agreement can be suspended until the disagreement is resolved.

Answered by David Cranford on June 16, 2025

Agent Licensed in OK, FL, IL, OH, TN & TX

Answered by David Cranford Medicare Insurance Agent

Derek Warren · Answer

Hospitals are taking advantage plans. They take both HMO and PPO. Network restrictions may apply but that’s part of a brokers responsibility to ensure that the specific advantage plan chosen would work for the doctors, specialist, hospital, etc. that an individual is using to know what plans would work for that individual. In addition to that would go off the cost of the medications to ensure that you will have both the network and the meds will be covered at the lowest out of pocket cost for the individual.

Answered by Derek Warren on November 3, 2025

Broker Licensed in OH & MI

Answered by Derek Warren Medicare Insurance Agent

Amanda Holder · Answer

That is a great question and there are lot of reasons that some hospitals may not be taking Medicare Advantage plans. The most important thing to remember is to check with your healthcare plan to determine whether the hospital you want to use is contracted with your plan.

Answered by Amanda Holder on September 8, 2025

Broker Licensed in FL, AZ, NC & VA

Answered by Amanda Holder Medicare Insurance Agent

Bobbi Lincoln · Answer

Most hospitals are no longer accepting Medicare advantage plans because private insurance frequently deny medical claims and require an exhausting amount of paperwork

Angela Tapp · Answer

I am so glad you asked this, because it is all over the news right now and it can sound very scary. The short answer is that Medicare Advantage plans are run by private insurance companies, and sometimes those insurance companies and local hospitals get into a big disagreement over how they do business. Hospitals are pushing back because they feel the insurance companies make them jump through too many hoops with paperwork, take too long to pay them, or deny claims for care that doctors say a patient needs.  

As your partner, I always keep a close eye on these changes. My job is to protect your health and your wallet, which means we will always check to make sure your preferred hospital and doctors are fully in-network before we pick a plan. And remember, if you ever want total freedom to see any hospital in the country without network rules, we can look at a Medicare Supplement instead. We will figure out what works best for your family together!

Why are hospitals not taking Medicare Advantage plans?

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Why are hospitals not taking Medicare Advantage plans?

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