Why are hospitals not taking Medicare Advantage plans?
Answered by 15 licensed agents
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.
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.
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.
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.
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
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.
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.
Some hospitals are not taking Medicare Advantage plans. Because of prior authorizations leading to higher administrative costs and reimbursements taking so long.
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.
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.
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.
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.
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.
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.
