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 ...

Gary Church · Answer

It's easy! Medicare Advantage plans often require referrals and deny services to their patients. Payment to doctors is affected. The insurance company wants to keep as much of the money given by Medicare.

Answered by Gary Church on September 23, 2025

Broker Licensed in Ca, AZ, NV & TX

Answered by Gary Church Medicare Insurance Agent

Steve and Sue Brauer · Answer

Hi, thanks for watching. So the question is, why do some doctors not like Medicare Advantage? Well, to be perfectly honest, the Medicare Advantage plan reimbursement to doctors, the fees that they pay doctors, are going to be less than that of original Medicare. It's not a huge amount, but it's definitely different than original Medicare. Some doctors have been practicing a long time, and they can afford it. They only accept people that are on a supplement or have original Medicare because the fee structure is bigger. It's just the way it is.

Daniel Brechin · Answer

There are many Physicians that accept Medicare Advantage plans.  I personally like MA plans and have been successful.
I have been selling MA plans since 1996.  I enrolled my self in 2014.  I did what I advise members to plan a savings amount and put in 150 per month in it and get a debit card for it to pay your co-pays.

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

Terri Reagin · Answer

They get paid less on them and there are more hoops to jump through to get procedures done. I am of the opinion that you really shouldn't base your decision on what to buy on whether or not it is your doctor's preferred plan. That is letting someone else's bias drive your decision and you should base it on what is right for YOU.

Answered by Terri Reagin on August 18, 2025

Broker Licensed in OK, AR, CO & 6 other states

Answered by Terri Reagin 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.

Voss Speros · Answer

Voss Speros here, Greek god of Medicare. Medicare is all Greek to you, and you are in luck, I'm Greek. So the question today is, why do doctors not like Medicare Advantage plans?

Okay, so there's probably a few reasons built into this one. One, doctors have to give pre-authorizations at times. No one likes that. Two, there's a lower reimbursement rate than Original Medicare for doctors, so they're getting paid less.

Three, I'd have to say is the paperwork on the back end to get approvals in versus denials. So there's a lot of, well, there's more work because this insurance company is trying to oversee the care to see if somebody needs it. So it has to be medically necessary to get it. Doctors can't just willy-nilly bill for anything like they can for Medicare. Now, not saying that they are, but some do.

So there's some oversight on these vendors' client side for the insurance companies not to have a bunch of fraud and wasted abuse, you know, to save Medicare. There's a lot of that going on because doctors can just bill for it. And then there's not a lot of paperwork, and they just kind of get paid. So, and you pay it even more.

So the reason they don't like it more, I would have to say the top thing is the reimbursement rate because at the end of the day, it's all about money. And everyone lies, like I've heard before. Like my wife says, it's all about money, and everyone lives. So it's the reimbursement rate, a lot of back-end paperwork, and pre-authorizations.

If you have any questions, give us a call. We'll be happy to answer them online. Have a great day!

Shelly Hefley · Answer

Physician staff do not like Advantage plans because there are extra prior authorizations and rules that need to be reviewed. They much prefer the easier Medicare and the Supplement route.

Luke Rhoads · Answer

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

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 don't matter if your Dr is not in network .

Answered by Ellen Diehl on February 5, 2026

Broker Licensed in GA

Answered by Ellen Diehl Medicare Insurance Agent

Sandra Teel · Answer

Medicare Advantage plans are run by insurance companies.  Medicare pays the insurance companies to manage the plans.  Each insurance company negotiates with the Medicare providers, like hospitals, doctors and labatories to decide how much they will pay for services.
Often these negotiations don't favor the Medicare providers so many providers are opting out of accepting Medicare Advantage plans.

Dutch VanHoesen · Answer

Medicare advantage plans pay doctors and other providers less than original Medicare pays. Also Medicare Advantage has authorizations and referrals that a provider may feel gets in the way of their prescribed method of care.

Answered by Dutch VanHoesen on July 17, 2025

Broker Licensed in FL

Answered by Dutch VanHoesen Medicare Insurance Agent

Mike Odle · Answer

If you ask a doctor I don't think you'll ever get a straight answer, but the reality is that in a lot of cases with Medicare Advantage they get reimbursed 90% of what they would get reimbursed from original Medicare. The good thing for a doctor is that original Medicare offers a lot more flexibility on treatments, and the bad thing about Medicare is that it offers a doctor a lot more flexibility on treatments. While Medicare Advantage covers the same services as original medicare, the Medicare Advantage plan likely has more protocols in place to cut down on waste and fraud than does original Medicare, such as prior authorization and referrals. Original Medicare doesn't have these restrictions, but is also one of the main reasons why it's projected to be insolvent by the year 2033. Despite the restrictions and pre-authorization, some studies do show that people on Medicare Advantage can have an adjusted life expectancy 9 to 15% longer than people on original Medicare because of the coordination of care involved with a Medicare Advantage plan.

Answered by Mike Odle on March 30, 2026

Broker Licensed in IN & IL

Answered by Mike Odle Medicare Insurance Agent

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

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.

Jane Baker · Answer

Doctors encounter problems with customers because customers are not instructed on the ins and outs of how to use their plans. For example an overnight hospital stay can be $300. in network but the customer has to pay 40% out of network on some plans.

Answered by Jane Baker on October 7, 2025

Broker Licensed in FL, AL, MS & TN

Answered by Jane Baker Medicare Insurance Agent

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.

Andrew Zurbuch, MBA · Answer

That is a question for medical Doctors. However, it may be the low Copays they receive for the medical treatment they provided. It may be the denial of claims or the step therapy process. It may be the slow payment of approved of claims or changes in the payment amounts.  

Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Leslie Kaz · Answer

You've probably heard that some doctors don't like Medicare Advantage. But let's be real, that doesn't mean the plans are bad. It usually means doctors don't fully understand how Medicare Advantage works today. Here's the truth: Traditional Medicare pays doctors for every service they perform. It's a fee-for-service system. The more they do, the more they make. Medicare Advantage flips that model. It focuses on keeping people healthy instead of just treating illness. Doctors and plans share responsibility for outcomes, not just procedures.

Now let's shift. This can feel uncomfortable for some providers. It means they have to follow care coordination, preventive care, and quality metrics, not just billing codes. And for smaller offices, it can feel like extra work. But here's the upside: Medicare Advantage plans often include things original Medicare never covered, such as vision, dental, hearing, gym memberships, over-the-counter benefits, and even grocery or transportation help. These aren't fluff. They're programs designed to keep people out of the hospital and living better, longer.

And that's exactly what frustrates some doctors. It's a new way of thinking. It's not about how many patients they see, but how well those patients do. So when a doctor says, "I don't take Medicare Advantage," what they really mean is, "I'm not set up for modern health care delivery." The best doctors today partner with these plans to keep their patients healthier, happier, and more supported. Medicare Advantage isn't the problem. It's the future of coordinated, preventative, patient-focused care.

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

Vernon Jones · Answer

Doctors often dislike Medicare Advantage (MA) plans due to high administrative burdens, such as strict prior authorization requirements,, which delay patient care and increase paperwork. Other major factors include lower reimbursement rates compared to Original Medicare, denied claims, and restrictive, narrow provider networks

Answered by Vernon Jones on May 11, 2026

Broker Licensed in NC & SC

Answered by Vernon Jones Medicare Insurance Agent

Hannah Skinner · Answer

Providers can dislike Advantage plans for a few reasons, but the two biggest reasons are likely dealing with authorizations and the declines. Doctors and hospitals are the ones who have to submit appeals and prior authorization requests which can be very frustrating and time-consuming. On top of being frustrating, if a request is denied then they do not get paid by the insurance company.

Answered by Hannah Skinner on December 19, 2025

Agent Licensed in SC, AL, AR & 44 other states

Answered by Hannah Skinner 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

Barbara Patterson, CFP · Answer

They have more procedures they have to get approved than original Medicare and the doctor’s reimbursement is usually less due to being in a network with a contracted rate.

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.

Lou Spatafore · Answer

Many providers are not accepting Medicare Advantage plans for a host of reasons. First of all there is an administrative burden and prior authorizations are required before services can be provided. This puts a strain on the doctors and the patients. They also don't receive payment in a timely manner which effects the practice's cash flow. To sum it up, the doctors don't like Advantage plans because it restricts their ability to provide the best care for their patients.

Answered by Lou Spatafore on March 2, 2026

Broker Licensed in WV, FL, GA & 10 other states

Answered by Lou Spatafore Medicare Insurance Agent

Tony Kiepe · Answer

CMS has just released its 2026 payments to carriers for 2027. The average increase for contracted carriers is 0.09%, and some counties in Washington are getting 0.02%. Doctors want more money, and the carriers are being paid less. Plans that are 4 Star or higher get paid more and can pay doctors more. A 4.5-star plan receives more money than a 3.5-star plan. Doctors do not want to accept average-rated plans because they receive lower reimbursement. A 4.5-star plan will cost around $1,500 more per year for healthcare management. Naturally, they can pay more to the doctor. The best action you can take is get a high-rated plan or a supplement plan. Carriers are reducing benefits. I believe you will see larger reductions in WA next year, including OTC, Dental, and other benefit types. Doctors get paid less under PPO plans; in Spokane, Multicare and Providence are no longer accepting PPO plans.

Answered by Tony Kiepe on March 2, 2026

Agent Licensed in WA, AZ, ID & MT

Answered by Tony Kiepe Medicare Insurance Agent

Dawn Young · Answer

That's a loaded question.  1.  Original Medicare is easy to work with as far as payment and approval for services.  2.  Just like Under 65 plans there are networks of doctors within Medicare Advantage plans.  Not all doctors are contracted with every carrier.  3.  Personally, I feel it is a bit selfish on the doctors part to not like Medicare Advantage as they do not have to pay the outrageous premiums for a Medicare Supplement Gap plans that work with Original Medicare.  Medicare Advantage plans must offer the same benefits as Original Medicare.  Medicare Advantage plans are managed by private insurance companies and not the Federal Government.  In other words, private insurance companies save money for beneficiaries and are able to offer additional benefits.  4.  On a positive note with a Medicare Advantage plan you do not pay or pay very little for coverage.  If you are not using the benefits you are not paying monthly premiums like you do with supplement or gap plans.  You pay as you go....

It really comes down to what works best for you and the coverage you are seeking.  It's not what the doctor wants.  It's what you want...

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.

Shawn Ray · Answer

Some doctors are hesitant about Medicare Advantage plans because of administrative requirements and payment structures. These plans often require prior authorizations, referrals, and additional paperwork, which can create delays and increase staff workload compared to Original Medicare.

Reimbursement rates can also be lower or more restrictive, and doctors must stay within specific networks to get paid. While many providers do participate and work well with Medicare Advantage plans, others prefer the simplicity and broader access that comes with Original Medicare.

Shrutep Amin · Answer

Some doctors prefer Original Medicare because Medicare Advantage plans often pay less, require extra paperwork and prior authorizations, and limit which patients they can see. Payments can be delayed or denied, and doctors sometimes have less freedom in treatment decisions.

Answered by Shrutep Amin on October 25, 2025

Agent Licensed in PA, NJ, OH & SC

Answered by Shrutep Amin Medicare Insurance Agent

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.

Vachik Chakhbazian · Answer

due to administrative burdens, lower reimbursement rates, and restrictions on patient care. These factors can lead to increased workload, financial strain, and limitations on treatment options for both doctors and patients.

Answered by Vachik Chakhbazian on August 8, 2025

Agent Licensed in CA, AL, AR & 22 other states

Answered by Vachik Chakhbazian 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

Mark Boone · Answer

Doctors may dislike Medicare Advantage plans because of lower reimbursement rates, administrative burdens like prior authorization, and restrictions on provider networks

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

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

Todd Bostic · Answer

With Medicare Advantage plans, the payment doctors get is limited, but some doctors don’t mind because they feel like they will get more patients and make more money, but with Medicare Supplements, they can actually charge a little higher, up to 15% higher and still get paid, but some people feel like they just want to be paid by the customers so they can charge whatever they want.

Answered by Todd Bostic on August 25, 2025

Broker Licensed in TX, AL, AZ & 12 other states

Answered by Todd Bostic Medicare Insurance Agent

Joseph Peck · Answer

Because they are private insurance and require pre authorizations and decline treatments that can take care of the patient.

James Wareheim · Answer

Their are two types of Medicare Advantage plans in general. HMO and PPO. Some doctors don't like the HMO since they are somewhat restrictive. But their are doctor groups the specialize in the HMO plans. The PPO plans are less restrictive, more doctors like these plans although the best benefits are if you stay in network.

Answered by James Wareheim on September 15, 2025

Agent Licensed in FL, GA, NC, NV & SC

Answered by James Wareheim Medicare Insurance Agent

Adam Morillo · Answer

That's a loaded question, but in simple terms. Doctors do not like Medicare Advantage plans for the for the following; prior authorizations, delay in care, lower and delayed reimbursements, increased administrated burden, and less flexibility in treatment decisions just to name a few.

Answered by Adam Morillo on July 9, 2025

Broker Licensed in FL, AK, AL & 48 other states

Answered by Adam Morillo Medicare Insurance Agent

Chad Hardy · Answer

Some doctors aren’t big fans of Medicare Advantage because it can create extra work and limit their flexibility. Many plans require prior authorizations before patients can get tests or treatments, which slows things down and adds paperwork. Doctors may also get paid less than with Original Medicare, and sometimes claims are denied or delayed. On top of that, the networks can be more restrictive, which means doctors can’t always refer patients as freely. All of this can make the care process feel more complicated than it needs to be.

Answered by Chad Hardy on October 6, 2025

Broker Licensed in TX, AL, AR & 8 other states

Answered by Chad Hardy Medicare Insurance Agent

Bud Griffin · Answer

It's a mistery to me why any doctor would not like Medicare Advantage. You would likely get different answers from every person you ask as to why they prefer their current coverage over Medicare Advantage. What is important to you would be the right choice for you, and that may very well be a Medicare Advantage plan of your choice after comparing each plans options.

Answered by Bud Griffin on October 27, 2025

Broker Licensed in TX

Answered by Bud Griffin Medicare Insurance Agent

Blaine Shipe · Answer

That question remains a guess. There are some doctors who feel they are not getting paid fast enough or at all. This another theory that Medicare Advantage plans limits the kinds of specialist that can be seen. The doctors are also accountable to act as a primary contact for all healthcare information. This may conflict with the specialists opinion. In conclusion, there is no real one good reason.

Answered by Blaine Shipe on December 14, 2025

Broker Licensed in AZ, CA, CO & VA

Answered by Blaine Shipe 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.

Earl Beck · Answer

Although Medicare Advantage plans offer beneficiaries a variety of attractive features, there are some aspects of these private plans that healthcare professionals may dislike.

While enrollees value these benefits, doctors may find some of the administrative hurdles associated with these plans to be challenging. Potential issues with Medicare Advantage plans include:

requiring prior authorization for procedures that Original Medicare does not
denying coverage for certain services
limiting members to strict provider networks

Larry Pereiro · Answer

Some dislike the Medicare Advantage plans because the contract between them and carrier eliminates the ability to do balanced billing. Others also may dislike them because it requires more accountability for the services rendered in relationship to the health needs of the consumer. These regulatory issues are or should help prevent fraud waste and abuse, ultimately reducing the cost of the consumer's health care overall.

Answered by Larry Pereiro on July 28, 2025

Agent Licensed in IN

Answered by Larry Pereiro 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.

Angelina Watkins · Answer

Doctors who accept Medicare Assignment typically do not dislike Medicare Advantage plans because they cover what Original Medicare covers plus additional benefits. Doctors do sometimes have concerns with denials of services that are medically necessary, but they just need to make sure they are providing all the proper documentation and getting the required authorizations for approval of the medically necessary service.

Answered by Angelina Watkins on November 24, 2025

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

Answered by Angelina Watkins Medicare Insurance Agent

Marta Iris González · Answer

Many doctors find Original Medicare simpler and faster to work with, while MA plans often come with more red tape and less flexibility — even though these plans can offer valuable benefits to patients.

Answered by Marta Iris González on November 3, 2025

Broker Licensed in FL, GA, NJ, OH & TX

Answered by Marta Iris González Medicare Insurance Agent

Angela Wainright · Answer

Doctors dislike Advantage plans, not because they are bad plans, but because of how they are structured behind the scenes. MA plans are run by private insurance companies, which often have prior authorization requirements, more paperwork, and tighter utilization controls. It can slow down the process of administering care to patients, which is certainly frustrating for all involved. Some plans also have limited networks, meaning doctors have to be in-network to get properly paid. Speed of payment can be another point of frustration: traditional Medicare pays promptly, some MA plans might reimburse doctors less, take longer to pay, or deny more claims. In short, Medicare Advantage Plans aren't a bad option; many people are very satisfied with their MA plan. Staying in-network and having minimal prior authorizations makes for a good experience. And so many enjoy the extra benefits like dental, vision, over-the-counter, and fitness benefits.

Answered by Angela Wainright on July 25, 2025

Broker Licensed in MN, AZ & ND

Answered by Angela Wainright Medicare Insurance Agent

Krystal Hampton · Answer

Why do doctors not like Medicare Advantage plans? Many doctors dislike Medicare Advantage plans because they may have lower reimbursement rates and more paperwork to complete. For example, prior authorization requirements and provider networks may constrain their ability to provide referrals or services. Likewise, hospitals and health systems have cited delayed reimbursements, cumbersome prior authorization requirements, and high rates of patient claim denials for their decisions to drop Medicare Advantage plans.

However, all of those same features allow Medicare Advantage plans to offer $0 monthly premiums, maximum out-of-pocket costs, and extra benefits like dental, vision, and hearing.

So if a doctor who has a private practice needs to submit a claim against one of their patients' Medicare Advantage plans and they mistype the wrong thing, say their billing department miscoded something or mistyped the wrong thing, then it can go a long way for that claim to be paid out, or it may go through prior authorizations, and that takes a long time. So that's really the main reason why some specific doctors don't like Medicare Advantage plans.

Then the other reason, which has been talked about on specific doctors' YouTube channels, is the fact that some of them claim they are not getting paid enough with specific insurance carriers that cater to Medicare recipients. So they're saying that they're not getting paid enough for that through a Medicare Advantage plan. So that's something completely sideways as well.

Do I think they have a legitimate claim as an insurance broker? I am not at liberty to say. I mean, that is between them and the insurance carrier and the Department of Insurance for the state they live in. So yeah, that's pretty much it as to why some doctors may not like Medicare Advantage plans. Now, always keep in mind though, that you can use an in-network doctor. You don't necessarily have to use any doctor that may feel that way. So I hope this helps. Bye.

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 an insurance plan tells 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

Marc Gilman · Answer

Why do doctors not like Medicare Advantage plans? Many doctors dislike Medicare Advantage plans because they may have lower reimbursement rates and more paperwork to complete. For example, prior authorization requirements and provider networks may constrain their ability to provide referrals or services. Likewise, hospitals and health systems have cited delayed reimbursements, cumbersome prior authorization requirements, and high rates of patient claim denials for their decisions to drop Medicare Advantage plans.

However, all of those same features allow Medicare Advantage plans to offer $0 monthly premiums, maximum out-of-pocket costs, and extra benefits like dental, vision, and hearing.

However, all of those same features allow Medicare Advantage plans to offer $0 monthly premiums, maximum out-of-pocket costs, and extra benefits like dental, vision, and hearing.

Annette Newman · Answer

Here is why your doctor might have a "love-hate" (mostly hate) relationship with them:

1. The "Prior Authorization" Paperwork
This is the number one complaint. In Original Medicare, if a doctor says you need an MRI or a specific surgery, you generally just get it.

The MA Reality: Private insurers often require "prior authorization" for services. This means your doctor’s staff must spend hours submitting paperwork to prove the service is necessary.

The Friction: In 2026, even with new laws requiring faster decisions (7 days for routine, 72 hours for urgent), doctors still find this an administrative nightmare that delays your care and increases their overhead costs.

2. Higher Denial Rates
Doctors get frustrated when they prescribe a treatment plan only to have an insurance company’s algorithm or remote medical reviewer deny it.

The Conflict: Studies consistently show that MA plans deny a higher percentage of claims than Original Medicare. When a claim is denied, the doctor either doesn't get paid or has to engage in a lengthy, unpaid appeals process to fight for your treatment.

3. "Narrow" Networks
Medicare Advantage plans save money by limiting you to a specific "network" of doctors.

The Doctor's Perspective: This makes referrals difficult. If your primary care doctor wants to send you to the best specialist in the city, but that specialist isn't in your plan's network, the doctor has to hunt for a "second-best" option that is covered. This limits their ability to provide what they consider the highest quality of care.

4. Reimbursement Lag & Lower Pay
In 2026, the gap between what Medicare pays doctors and what it costs to run a practice has widened.

The Money Trail: While the government increased payments to MA insurance companies by about 4.3% for 2026, many doctors saw their actual reimbursement rates stay flat or even decrease.

The Result: Some hospitals are "dropping" certain MA plans entirely because the administrative cost.

Kyle Nystrom · Answer

One major reason is Prior Authorizations - the re-checking behind and subversion of the licensed medical doctor's professional, licensed opinions and recommendations. Medicare Advantage plans give authorization to carry out a treatment or procedure prior to covering. If no authorization, no coverage. Doctors converse back and forth with Advantage plans regarding "is this really necessary" and "are we sure this is the correct diagnosis" and "are you sure the patient has done x, y and z" etcetera in efforts to cover as little as possible.

Answered by Kyle Nystrom on April 28, 2026

Agent Licensed in VA

Answered by Kyle Nystrom Medicare Insurance Agent

Michael Reardon · Answer

Who won the doctors do not like Medicare advantage plans because some plans require prior authorization and they do not like jumping through extra hoops to get services provided for their clients.

Cynthia Haworth · Answer

That is an incorrect statement.  Not all Doctors accept regular Medicare or Medicare Supplements.  Our Doctor only accepts Advantage Plans!!!

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

Josie Villa · Answer

Many doctors are hesitant about Medicare Advantage plans because of their structure compared with Original Medicare. The issue isn’t universal—some doctors accept and work with these plans—but several common concerns come up.

Answered by Josie Villa on March 16, 2026

Broker Licensed in IL

Answered by Josie Villa Medicare Insurance Agent

Wayne Victor · Answer

Many doctors dislike Medicare Advantage plans because they often involve restrictive networks and more administrative hurdles, like prior authorizations. They also tend to pay providers less than traditional Medicare, which can affect scheduling and reimbursement.

Answered by Wayne Victor on October 27, 2025

Agent Licensed in CO, AZ, FL & 8 other states

Answered by Wayne Victor Medicare Insurance Agent

Nikki Reid · Answer

MA plans are run by private insurance companies, not traditional Medicare and take longer in processing claims. MA require prior authorizations which is a lot of paperwork and MA have limited networks.

Answered by Nikki Reid on October 8, 2025

Broker Licensed in TN

Answered by Nikki Reid Medicare Insurance Agent

Evelyn Ayala · Answer

Doctors may not like Medicare Advantage (MA) plans due to administrative and billing issues. There also maybe network restrictions limiting referrals, lower reimbursement rates compared to Original Medicare

Answered by Evelyn Ayala on January 12, 2026

Agent Licensed in NY

Answered by Evelyn Ayala Medicare Insurance Agent

Why do doctors not like Medicare Advantage plans?

Agents: Share Your Expertise

Seniors: Ask a Question of Your Own

Related Questions

Agent Locator

Medicare Agents Hub
A non-government resource website

Why do doctors not like Medicare Advantage plans?

Agents: Share Your Expertise

Seniors: Ask a Question of Your Own

Related Questions

Agent Locator

Medicare Agents HubA non-government resource website

Medicare Agents Hub
A non-government resource website