Hospitals sick of fighting for Medicare Advantage dollars

Becker's Healthcare October 10, 2024
Alan Condon

Health systems are growing increasingly frustrated with fighting to receive payments from insurers in the Medicare Advantage program, which now provides health coverage to more than 55% of the nation’s older adults, about 33.8 million people.

MA continues to grow, but so do its administrative challenges, as health insurers prioritize their margins in the segment.

Hospitals are the most vulnerable provider to rising administrative and financial MA burdens, “given growing risks to reimbursement from MA plans relative to traditional Medicare, as well as the payment risk and higher complexity around prior authorization requirements,” according to a recent report from S&P Global. “We also see future risks to providers if at some point CMS addresses the MA program’s higher-than-expected...

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