Medicare plays a vital role in helping older adults and people with disabilities access health care. One part of Medicare has grown rapidly over the past couple of decades – Medicare Advantage. While many patients prefer these plans—hospitals, clinicians and, increasingly, patients are experiencing intensifying challenges that call for meaningful reform.
A quick overview of Medicare Advantage
Medicare Advantage (also known as Medicare Part C) is an alternative to “Original Medicare.” Instead of receiving benefits directly through the federal government, beneficiaries enroll in a private insurance plan approved by Medicare. These plans are required to cover the same services as traditional Medicare and often offer additional benefits, such as dental, vision, hearing or gym memberships.
Medicare Advantage first crossed the 50% adoption threshold in 2023. Last year, 54% of all Medicare beneficiaries nationwide were enrolled in Medicare Advantage plans – more than 34 million Americans nationwide.
When Medicare Advantage plans work well, they are an important component in supporting coordinated care, preventive services and trying innovative approaches to keeping patients healthy. When they do not work, it can spell trouble for patients, doctors and hospitals alike.
Challenges patients and providers are facing
One of the most common concerns with Medicare Advantage is the use of prior authorization, a process that requires approval from the insurance plan before care can be provided. While prior authorization is intended to ensure appropriate use of services, it is often applied too broadly or inconsistently, leading to delays in care.
In 2024 alone, Medicare Advantage insurers made nearly 53 million prior authorization decisions, denying care in almost 8% of cases. When patients or providers appealed those denials, more than 80% were overturned, suggesting that many initial denials were not clinically justified. For patients, these delays can mean worsening health, increased stress and confusion during already difficult moments.
Beyond delays, coverage denials themselves have become a growing problem. Hospitals and providers report more frequent instances in which Medicare Advantage plans deny payment for care that would typically be covered under traditional Medicare, even when care is medically necessary and provided in accordance with accepted clinical standards.
The impact is not only frustrating for patients, but also financially significant for hospitals and providers. National hospital data show that revenue losses tied to Medicare Advantage denials have surged by more than 55% since 2022, contributing to sharply declining cash reserves across health systems nationwide. As margins tighten, hospitals have fewer resources to invest in staff, equipment and services that directly benefit patients and communities.
Although Medicare Advantage plans are required to cover the same services as traditional Medicare, narrow provider networks and restrictive internal coverage rules can further limit access to care and disrupt continuity of care.
Key reform priorities
Asante strongly supports reforms to Medicare Advantage that ensure the program works effectively for patients, providers and hospitals, and endorses the clear, practical solutions advanced by the American Hospital Association to strengthen the program while safeguarding beneficiaries.
Key reform priorities include:
- Strengthening oversight and accountability to protect patients and safeguard the long-term sustainability of the providers that participate in the Medicare program.
- Reducing inappropriate prior authorization by ensuring decisions are timely, transparent and grounded in clinical evidence, not administrative barriers.
- Requiring greater transparency so patients and providers clearly understand what is covered and why care is denied.
- Ensuring Medicare Advantage plans follow Medicare rules, including covering services that are available under traditional Medicare.
These changes are about ensuring the Medicare Advantage program fulfills its promise. Patients enroll in these plans expecting their care to be covered, and hospitals expect insurer partners to follow the rules, avoid unnecessary denials and pay promptly so patients can receive care when they need it.
We support reform and continued action to strengthen Medicare Advantage so it reliably serves patients and supports the healthcare providers who care for them.
Sources
- Kaiser Family Foundation (KFF). Medicare Advantage in 2025: Enrollment Update and Key Trends. https://www.kff.org/medicare/medicare-advantage-enrollment-update-and-key-trends/
- Centers for Medicare & Medicaid Services (CMS). Medicare Advantage/Part D Contract and Enrollment Data. https://www.cms.gov/data-research/statistics-trends-and-reports/medicare-advantagepart-d-contract-and-enrollment-data
- American Hospital Association (AHA). Providing Solutions to Address Challenges with MA Plans. February 6, 2026. https://www.aha.org/news/perspective/2026-02-06-providing-solutions-address-challenges-ma-plans
- Healthcare Finance News. Hospitals confront mounting reimbursement challenges and diminishing cash reserves. November 30, 2023. https://www.healthcarefinancenews.com/news/hospitals-confront-mounting-reimbursement-challenges-and-diminishing-cash-reserves
