Medicare Advantage plans, also called Medicare Part C, are health insurance plans offered by private health insurance companies in collaboration with Medicare.
This popular alternative to Original Medicare now has about 30.8 million enrollees, 51% of all Medicare-eligible beneficiaries.
Regardless of its popularity, Medicare Advantage plans continue to face scrutiny from doctors and healthcare professionals.
In fact, the Medscape Physician Compensation Report of 2023 indicated that only about 35% of doctors are willing to take on new Medicare patients. This is a significant decrease from 29% unwilling to do so about five years ago.
But why do doctors not like Medicare Advantage plans? Many doctors and healthcare physicians don’t like Medicare Advantage plans due to coverage restrictions, limited networking, and overpayment rates, which cause increasing difficulties for patients.
Since pre-authorization and referral requirements often impede patients’ needs, doctors refuse to accept these plans. However, these issues often affect patients who are stuck in the middle of the turmoil.
Let us learn more about Medicare Part C and the increasing dislike of doctors towards these popular healthcare insurance plans.
Growing Discontent With Medicare Advantage Plans
Various Medicare-approved private health insurance companies offer Medicare Part C, which provides senior adults with the same coverage as Original Medicare Parts A and B but with additional benefits.
These additional benefits, such as coverage for dental, vision, hearing, and wellness programs, are covered under one policy. Therefore, Medicare Advantage plans work as a hybrid of Medicare and private health insurance.
However, regardless of the increasing popularity of Medicare Advantage plans among patients, doctors, and healthcare physicians continue to reject them as they feel they push them to the edge.
This causes numerous problems for patients whose preferred healthcare professionals or hospitals refuse coverage. In this case, they may have to revert to Original Medicare or Medigap policies.
For instance, about 30,000 people in San Diego need to find new healthcare providers as two Scripps Health-affiliated medical groups refused to work with Medicare Part C insurance plans.
6 Reasons Doctors Dislike Medicare Advantage Plans
In recent years, doctors have resisted Medicare Advantage plans due to financial constraints, restricted patient care, and administrative burdens.
Let us examine these key factors causing the aversion toward Medicare Part C plans.
- Financial Reimbursem*nt Issues
Medicare Advantage plans often impose financial constraints that avert doctors. Since private health insurance companies offer Medicare Advantage plans, the providers within their network receive a fixed payment.
Medicare pays private health insurance companies, which have a limited budget for the providers. Thus, the cost management by private companies doesn’t pay the doctors well.
According to studies, private Medicare Advantage plans reimburse doctors at rates 86% of what Medicare initially pays. Such low reimbursem*nt affects doctors’ revenue, especially in practices with a high rate of Medicare Advantage patients. This significant disparity is the primary reason doctors are unwilling to accept Medicare Advantage plans.
- Administrative Burdens
Medicare Advantage plans cause considerable administrative burdens—often more than that of Original Medicare.
Navigating complex processes regarding approval, documentation, and adherence to strict service provision guidelines also causes distress among doctors and healthcare staff.
According to the American Medical Association, healthcare professionals spend approximately 16 hours per week managing their pre-authorization requests from Medicare Advantage plans. This administrative work diverts resources and causes physician burnout, leading to doctors disliking Medicare Advantage plans.
- Limitation of Network Providers
As Medicare Advantage plans only operate within a network of healthcare providers, physicians are restricted from referring patients to other specialists.
For doctors, this means that they can only see patients with Medicare Advantage. If they have previously treated or referred a patient, they may not be able to continue treatment without Medicare Advantage.
Moreover, doctors cannot refer patients to specialists outside the network. This limits patient care, affecting the treatment significantly.
Healthcare providers also require pre-approval for specific treatments or tests. This can delay patient care, causing numerous health problems. Thus, limitations and restrictions can negatively impact doctors and patients within the Medicare Advantage network.
- Quality of Care Concerns
Medicare Advantage plans come with additional benefits including cost savings but these plans may not always offer the best healthcare. Since these healthcare plans cut costs they do not provide the best medical services to patients.
This could also mean that patients cannot have specific tests under these plans as they may be costly. This cost containment leads to underutilization of medical services as patients are less likely to receive high-cost, potentially life-saving medical treatments.
According to a study by the Journal of the American Medical Association, patients enrolled in Medicare Advantage are less likely to receive high-cost, life-saving treatments than those with Original Medicare.
For doctors, this raises ethical concerns as they are bound by private Medicare Advantage plans and cannot provide the best possible care, compromising patient health.
Due to the overstepping of ethical boundaries, Medicare Advantage’s cost containment has led doctors to develop a negative view of these plans.
- Doctors’ Perspectives and Experiences
Firsthand experiences regarding Medicare Advantage plans have shaped doctors’ perspectives. From their impact on private practice to patient care, doctors have consistently disapproved of Medicare Advantage plans, their pre-approval processes, reduced reimbursem*nt rates, and limited networks.
Moreover, doctors show frustration over cost-saving treatment measures that impact the ethical obligation of providing the best possible care to patients. Thus, the constraints of Medicare Advantage plans have doctors questioning these plans as a business solution and less of a healthcare service.
- Negative Impact on the Healthcare System
Medicare Advantage plans are now more widespread than ever, with more than 30 million enrollees. However, this brings broader implications for the healthcare system and patient care.
The cost containment measures, along with the limited network, represent the importance of financial consideration over patient care.
Plus, the disparity in reimbursem*nt rates tarnished the reputation of Medicare Advantage plans, suggesting their intent to establish a fragmented healthcare system.
Under this system, a patient’s insurance type is prioritized over their medical needs. This implies that the quality of care you receive is directly influenced by the type of Medicare plan you have, irrespective of the critical nature of your treatment.
These factors significantly impact patient care, and doctors’ dissatisfaction with these plans seems justified unless policymakers introduce changes, making the process more streamlined and patient-centric.
Summarized | Limitations, Doctors’ Discontent, and Effect on Patient Care
Medicare Advantage plans have had exponential growth in recent years. But now, it’s imperative for private insurance companies and policymakers to uphold the principles of patient-centric care as it is the primary concern for doctors.
Let us look into the limitations of Medicare Advantage plans, doctor’s growing discontent, and its impact on patient care.
| Limitations of Medicare Advantage Plans | Doctors’ Discontent | Effect on Patient Care |
|---|---|---|
| Network restrictions | Lower reimbursem*nt rates | Reduced access to preferred providers |
| Pre-authorization requirements | Increased administrative burden | Potential delays in receiving care |
| Underutilization of services | Constraints on providing optimal care | Compromised quality of care |
Make an Informed Choice With Professional Guidance Through Silveredge
Medicare Advantage plans may be a one-stop solution for all your medical needs, but many healthcare professionals and facilities prefer Original Medicare.
Regardless of the growing discontent amongst doctors, it’s vital for you to evaluate your healthcare needs and enroll in a plan that suits you best.
With the expertise of Silveredge licensed advisors, you can evaluate and compare various Medicare plans to understand all your available options.
With professional advice, you can choose a plan that is not only cost-efficient but also tailored to your needs!
