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What should you do if the hospital drops your Medicare Advantage plan?

Hospitals and healthcare systems in 11 states have stopped accepting Medicare Advantage plans because of authorization issues.

Hospitals and healthcare systems in 11 states have stopped accepting Medicare Advantage plans because of authorization issues.
Cavan ImagesGetty Images/Cavan Images RF

A number of hospitals around the United States have dropped Medicare Advantage plans, mainly as a result of issues with prior authorisations. Becker’s Hospital Review, a medical industry trade magazine, announced at end of 2023 that hospitals and healthcare systems in 11 different states would be dropping some, and in some cases all, such plans.

Why are Medicare Advantage plans being dropped?

With Medicare Advantage plans requiring patients to get prior authorization for additional services in comparison to Original Medicare, those authorizations often take significantly longer to be accepted and are frequently denied, costing everyone involved, hospitals and patients alike, time and money, in addition to not ultimately providing adequate care.

How can I enroll for Original Medicare?

Anyone who has been affected by the changes may have to think about switching plans. If your hospital has dropped your plan and there isn’t another suitable Medicare Advantage plan available, you have the option to change back to Original Medicare during certain enrolment periods, specifically between 1 January and 31 March each year. The main obstacle could be finding an affordable Medicare Supplement Insurance (Medigap) plan if you’d like to have that extra insurance.

Conoce lo que debes hacer si se te pasó la fecha límite del período de inscripción abierta u open enrollment de Medicare.
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Patients can enroll for Original Medicare between 1 January and 31 March each year.IntegrityGetty Images

When can I enroll for 5-star Medicare?

Alternatively, it may be possible to switch to a 5-star Medicare plan in your area, which you can do during the 5-Star Special Enrollment Period; patients can sign up on one occasion between 8 December and 30 November the following year.

As you might imagine, though, it’s probably best to do your research before opting for any new plan. Speaking to Nerdwallet, Meredith Freed, senior policy manager for the Program on Medicare Policy for KFF, advises: “If you’re considering switching because you’re concerned about having access to a specific provider or hospital, I would suggest calling the provider to make sure they’re in-network for any plan you’re considering.”

If you happen to be outside of an enrollment period, you will have likely have little choice but to wait until its comes back around. Unless, that is, you opt to take drastic measures and move to an area where Medicare Advantage plans are still accepted. Let’s hope it doesn’t have to come to that.