10/29/2025
Medicare Advantage Plans:
⚠️ Risks of Enrolling in a Medicare Advantage Plan
High Prior Authorizations:
In 2023, MA insurers processed 50 million prior authorization requests — 6.4% were denied (KFF).
Frequent Claim Denials:
About 17% of Medicare Advantage claims are denied initially, and over half are later overturned on appeal.
Delayed or Denied Care:
Commonly affects post-acute rehab, skilled nursing, and imaging — even when services meet Medicare rules.
🔍 How It Differs from Original Medicare
Original Medicare: Federal program, no networks, minimal prior authorizations, freedom to see any provider.
Medicare Advantage: Private insurers manage care — prior authorizations, limited networks, and potential delays.
MA may include extras (dental, vision, etc.) but adds administrative barriers that can delay or deny care.
✅ Bottom Line
Extra perks come with trade-offs. Before enrolling, ask:
➡️ How often do they deny care?
➡️ How easy is it to appeal?
➡️ Are your preferred doctors and hospitals covered?