According to a recent NBC report, Medicare Advantage, AKA “MA” or “Medicare Part C”, declines roughly one in five claims, even when following Medicare rules. When medical claims are declined, this hurts both the patient and the hospital. Some rural hospitals state that Medicare Advantage claims denial is forcing them into bankruptcy.

Hospital directors say some facilities are empty due to billing issues with Medicare Advantage.

Medicare Advantage’s Effect: Hospitals in Trouble

NBC’s report (see below) exposed the challenges faced by hospitals, particularly in rural areas, due to Medicare Advantage declined claims. In the piece, Hospital CEO’s claim that some Medicare Advantage plans routinely deny reimbursements for vital care, affecting around 31 million enrollees. About 20% of claims faces denial, even when following Medicare rules.

A report by the Center for Healthcare Quality and Payment Reform confirms a concerning trend. After surveying six states—Arkansas, Colorado, Mississippi, Missouri, South Dakota, and Texas—it warned that 170 rural nonprofit hospitals are in danger of closure.

Dr. Kenneth Williams, CEO of Alliance HealthCare, expressed concern over MA plans. He noted, “They don’t want to reimburse for anything—deny, deny, deny. They are taking over Medicare and taking advantage of elderly patients.”

There are roughly 300 hospitals at immediate closure risk nationwide. An additional 300 could face closure in the next six to seven years. (Source)

Medigap is different than Medicare Advantage

While the report focused on how Medicare Advantage plans can decline up to 20% of claims, this is different that Medigap. Medigap plans (also known as Medicare Supplement plans) work in tandem with Medicare and cannot decline US-based Medicare claims. So if you are concerned that your current Medicare Advantage plan might decline your future claims, you may want to consider switching to Medigap.

How to Switch from Medicare Advantage to Medigap?

Seniors on Medicare Advantage can transition to a Medicare Supplement Plan through four potential options. The first two assure approval, while the third and fourth options require answering specific medical questions for approval:

  1. Switch during your first year of Medicare Advantage
  2. Switch during Special Enrollment Period
  3. Switch during the Annual Election Period (Oct 7 – Dec 15) REQUIRES MEDIGAP UNDERWRITING
  4. Switch during the Medicare Advantage Disenrollment period (Jan 1 – Feb 14) REQUIRES MEDIGAP UNDERWRITING

For a detailed guide on available possibilities, check our guide on Switching to MedSup.

Next Steps

Before transitioning to a Medicare Supplemental plan, make sure it fits your budget. Get an instant Medigap quote here. Always confirm you will be approved for Medigap before canceling your MA plan. For personalized help, contact our Senior65.com team at 800-930-7956.

There is NEVER a charge or hidden fee to work with us and no one can sell the same Medigap plan for less than Senior65.com can.