Why do doctors not like Medicare Advantage plans?

Question

Annelies Van Schie · Accepted Answer

For Medical services and procedures, doctors need to bill the Insurance company you have your Medicare Advantage plan with. For certain services/procedures, pre-authorization is needed which takes longer with dealing with an insurance company. 

If you have a Medicare Supplement Plan (also called a Medigap plan) such as Plan F, G, or N then the billing and medical services pre-authorization request goes to Medicare direct, which is a simpler process. 

Both billing and pre-authorization might just be simpler and quicker for the doctors to deal with. The administration with a Medicare Advantage insurance company might be more work for the doctors' administrative office.

Hope this helps ...

Lt Col Tim Brown · Answer

Your question is all encompassing as if all doctors don’t like them. I don’t think that is the case. They probably have more paperwork with that program. Sounds like a question for your doctor what they think and why.

Answered by Lt Col Tim Brown on May 2, 2025

Broker Licensed in TN, AL, CO & 10 other states

Answered by Lt Col Tim Brown Medicare Insurance Agent

Mark Maliwauki · Answer

Doctors often disapprove of Medicare Advantage plans due to issues with pre-authorization requirements, frequent claim denials, complex administrative processes, and reduced reimbursement rates. These challenges can lead to increased administrative burdens for doctors, impacting patient care and potentially leading to burnout. 

There are explanations for all of these that would counter the Doctors dislike. A big one is PA and claim denials. Both of these have been around long before MA plans. PAs are helpful for all involved. Claim denials more often than not are the result of a miscoded procedure at the provider (doctor, hospital) level.

David Silver · Answer

1. More Red Tape & Prior Authorizations
MA plans often require prior approval for tests, procedures, and even some medications.

This creates extra administrative work for doctors and delays care for patients.

2. Lower and Delayed Reimbursement
Compared to Original Medicare, MA plans may:

Pay lower rates

Take longer to reimburse

Dispute more claims
This can strain smaller or independent practices financially.

3. Limited Networks
Many MA plans have narrow networks, meaning:

Doctors must contract with the plan to see patients

Some patients can't continue with their preferred doctor unless they switch plans

Doctors may choose not to participate in some MA networks to avoid the hassles.

4. Complex Plan Variability
Every MA plan is different — even within the same insurance company.

This creates confusion for both patients and providers when trying to determine what’s covered and how much the patient owes.

5. Care Delays That Affect Patients
Delays from denials or prior auths can negatively affect patient outcomes.

Doctors may feel these plans interfere with clinical decision-making.

To be fair, Medicare Advantage can offer good value for some patients — especially those looking for lower premiums and extra benefits like dental or vision — but from a doctor’s point of view, it can feel like a bureaucratic burden.

Anthony Castelluccio · Answer

I am not a Doctor, so I can only assume that they might not like Medicare Advantage plans too much because they may not get paid as much for certain services. Medicare Advantage plans are considered managed care plans, so many time the Dr and patient have to get prior authorizations for certain procedures, this could delay the patients care and take administrators time and energy.

Answered by Anthony Castelluccio on April 21, 2025

Agent Licensed in PA, DE, MD, NJ & VA

Answered by Anthony Castelluccio Medicare Insurance Agent

Luke Rhoads · Answer

Providers dont like medicare advantage plans because of the administrative complexity, lower reimbursement rates, and requirements for prior authorization.

Jason Rubin · Answer

Doctors dislike Medicare Advantage plans due to administrative burdens, low reimbursement rates, and frequent denials of care, which impact their practice and patient care.

Chad Cason · Answer

Doctors often have mixed feelings about Medicare Advantage (Part C) plans for various reasons, such as:

1. Lowered and delayed reimbursement compared to Original Medicare.

2. Plans often require pre-approvals (prior authorizations) for tests, procedures, and certain medications, which means extra paperwork and delays in care, frustrating both doctors and patients.

3. Networks - If a doctor isn't in-network, patients may need to switch doctors or obtain referrals, which can cause frustration and disrupt the continuity of care.

4. More administrative duties. Dealing with different insurance companies (each with its own rules) adds complexity and time. Staff must spend more hours on the phone, filling out forms, and managing denials or appeals.

Doctors prefer Original Medicare because it's more predictable, pays faster, and involves less red tape. While some doctors participate in Medicare Advantage plans, many either opt out or view them as more challenging to work with, especially when it comes to obtaining timely and appropriate care for patients.

Steven Bleicher · Answer

Doctors have three main reasons for disliking MA plans: A) they don't want to do the paperwork involved with these types of (free of premiums, govt-subsidized) plans, B) due to that paperwork, they would be forced to hire more people to administer the plans, and 
C) Advantage plans take much longer to pay the in and out of network physicians and thus want nothing to do with any Advantage plan. But they gladly take on patients with Medicare Supplements, a.k.a., Medigap plans.

Michael Pyers · Answer

Because of extra work involved with referrals, pre-certifications, and the fact that most HMO's don't pay enough for the extra work. You can tell if your doctor has only HMO's, his office address is lot 13 Oak Grove Trailer Park.

Answered by Michael Pyers on May 7, 2025

Broker Licensed in OH & MI

Answered by Michael Pyers Medicare Insurance Agent

Cathy Barnett · Answer

That may have been the case a few years back but I’m enrolling quite a few doctors in a Medicare Advantage plan recently.   
I think the reason doctors were apprehensive about the MAPD plans was because they weren’t getting reimbursed as much accepting patients with a MAPD plans.

Jan Breheny · Answer

Medicare Advantage plans are managed care plans. This means that the insurance companies have the ability to require different things to receive care like preauthorizations, step therapies, and limitations on certain types of procedures.

Answered by Jan Breheny on March 31, 2025

Broker Licensed in MO

Answered by Jan Breheny Medicare Insurance Agent

Fred Manas · Answer

Doctors often dislike Medicare Advantage plans due to administrative burdens, claim denials, and slow payment issues. These plans also have strict network rules & can require prior authorization, which can delay or impede patient care. Furthermore, some Medicare Advantage plans may not cover medically necessary care that would be covered under Original Medicare, & some doctors are hesitant to accept new patients with these plans. 
Here's a more detailed breakdown of the issues:
1. Administrative Burdens and Claim Denials: Doctors face a complex process of navigating different plan rules & authorization requirements, leading to increased administrative costs & paperwork. Claim denials for services that should have been covered under Medicare rules are a common concern. The process of appealing denials can be time-consuming & frustrating. 
2. Slow Payments & Reduced Reimbursements:  Medicare Advantage plans may offer lower reimbursement rates compared to Original Medicare. Delays in receiving payment can strain a practice's finances, especially for smaller practices. 
3. Provider Network Restrictions & Referral Requirements:  Medicare Advantage plans often have strict network rules that limit patient choices & access to specialists. 
Referral requirements & prior authorization processes can delay or impede necessary care. 
Some plans require patients to switch to a preferred specialist before being seen, even if their preferred specialist is qualified & capable. 
4. Lack of Transparency & Control: Doctors may not agree with the insurance company's decisions on treatment options, leading to disagreements & potential delays in care. 
The complexity of Medicare Advantage plans can make it difficult for patients & doctors to understand coverage and potential costs. 
5. Impact on Patient Care: Administrative burdens & network restrictions can take time away from patient care. 
Some doctors have withdrawn from networks or refuse new Medicare Advantage patients.

Marcie Barnes · Answer

This is just a theory, I would ask a doctor why. Doctors prefer original Medicare and a Medicare supplement plan because they get paid more. Medicare Advantage plans have contracts and negotiated rates.

Answered by Marcie Barnes on May 6, 2025

Agent Licensed in TX, AK, AL & 48 other states

Answered by Marcie Barnes Medicare Insurance Agent

Andrew Kramer · Answer

HMO Advantage plans require Dr's to follow "metrics of care." They need staff to do that. But the outcome for a patient is much better! Actually, Dr's who are on "risk" Advantage plans make a lot of money, but they need to have a large client base on risk plans and the staff to support the documentation and referrals. A risk plan means the Dr is responsible to share the cost of care outside of his/her office, meaning specialist visits, ER, hospital, advanced imaging, etc. A practice that has a large Advantage plan client base can handle that and still make a lot of money.

Answered by Andrew Kramer on May 10, 2025

Agent Licensed in FL

Answered by Andrew Kramer Medicare Insurance Agent

Suzanne Lamperti · Answer

Medicare Advantage plans are a lot more restrictive than regular Medicare and require referrals and advanced approvals. This puts doctors and patients at a disadvantage when care is necessary and urgent.

Answered by Suzanne Lamperti on July 1, 2025

Broker Licensed in MD

Answered by Suzanne Lamperti Medicare Insurance Agent

Mary Salmon · Answer

Doctors who dislike Medicare Advantage plans primarily because MA plans require prior authorization for many services. This can lead to delays in treatment for the beneficiary. Also MA plans pay significantly less than Original Medicare so the doctors are not reimbursed as well. With the added burden of dealing with prior authorizations and less pay, many doctors prefer not to deal with MA.

Answered by Mary Salmon on May 12, 2025

Broker Licensed in TX & OK

Answered by Mary Salmon Medicare Insurance Agent

Tony Merwin · Answer

More and more doctors are accepting them now, but generally it comes down to payment, and ease of doing business.

Ellen Diehl · Answer

Because the Advantage plans are MCO Managed Care Organizations who are trying to add profit to their bottom line. They pay less to the Dr and have more restrictions on what they will cover for you. When the rubber meets the road your "grocery card" benefits matter if your Dr is not in network .

Answered by Ellen Diehl on April 7, 2025

Broker Licensed in GA

Answered by Ellen Diehl Medicare Insurance Agent

Rachael Metcalf · Answer

It isn't that they don't like them per se...it is because they have a higher oversight. Things need to be approved by the carrier. They like to just run the tests for payment on original medicare. They do not want to have a insurance plan tell them no. Now, this could be a good thing and maybe a frustrating thing. But medicare abuse is a real thing.

Answered by Rachael Metcalf on April 23, 2025

Agent Licensed in TN, FL, GA & 5 other states

Answered by Rachael Metcalf Medicare Insurance Agent

Natalee Nimmo · Answer

Because they don’t get paid properly nor in a timely manner. They say that they never know how much they are going to get paid or when.

Penny Wegner · Answer

Because everything has to go through a pre-authorizion process, the doctors feel like the insurance carriers have to much control over patients health care. Medicare Supplements typically do not need referrals.

Answered by Penny Wegner on April 15, 2025

Agent Licensed in WI, CA, CO & 8 other states

Answered by Penny Wegner Medicare Insurance Agent

Why do doctors not like Medicare Advantage plans?

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