KFF July 23, 2024
Enrollment in Medicare Advantage has grown rapidly in recent years, with more than half of all eligible Medicare beneficiaries now receiving their Medicare coverage from a private plan. The rise in Medicare Advantage enrollment has implications for beneficiaries and health care providers, including hospitals, because Medicare Advantage differs from traditional Medicare in many ways.
Unlike traditional Medicare, Medicare Advantage plans often require prior authorization before covering some services. Virtually all Medicare Advantage enrollees are in a plan that requires prior authorization for inpatient hospital stays (98%) and post-acute skilled nursing facility stays (99%). Prior authorization requirements are intended to reduce unnecessary care and lower costs, but also impose administrative burdens on health care providers, and could lead to delays and...
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