Tessa Quinn
While the vast majority of hospitals accept Original Medicare (Parts A and B), there are some that do not accept Medicare Advantage Plans. Medicare Advantage Plans, also known as Medicare Part C or MA Plans, are an alternative to Original Medicare and are offered by Medicare-approved private insurance companies. Hospitals that do not accept Medicare are often Veterans Affairs and active military hospitals, as they operate with different benefits. However, some hospitals are dropping Medicare Advantage Plans due to excessive prior authorization denial rates, slow payments from insurers, and financial challenges. This has resulted in limited access to healthcare for patients enrolled in Medicare Advantage Plans, as they may need to seek care at specific network hospitals.
| Characteristics | Values |
|---|---|
| Number of hospitals that accept Medicare | Over 7,000 |
| Hospitals that do not accept Medicare | Veterans Affairs and active military hospitals |
| Medicare Advantage plans coverage | Over 31 million Americans |
| Hospitals dropping Medicare Advantage plans | Samaritan Health Services, Cameron Regional Medical Center, Stillwater Medical Center, St. Charles Health System, York-based WellSpan Health, ECU Health, WakeMed, Nebraska hospitals |
| Reasons for dropping Medicare Advantage plans | Delayed reimbursements, excessive prior authorization denial rates, slow payments from insurers, high administrative burden |
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What You'll Learn
Hospitals that don't accept Medicare Advantage plans
While the vast majority of hospitals accept Original Medicare (Parts A and B), not all hospitals accept Medicare Advantage plans. Medicare Advantage plans offer additional coverage beyond what Original Medicare provides and have an out-of-pocket limit, which can be beneficial for individuals on a fixed budget. However, a growing number of hospitals across the country have been dropping Medicare Advantage plans due to issues with prior authorizations, denials, and administrative delays. Hospitals in at least 11 states announced in 2023 that they would be out-of-network for some or all Medicare Advantage plans in 2024.
Some specific examples of hospitals that have dropped or plan to drop Medicare Advantage plans include St. Charles Health System in Oregon, which announced it would be dropping three Medicare Advantage providers in 2024 due to concerns about restrictions on patient care, longer hospital stays, and administrative burdens. Additionally, Cameron (Mo.) Regional Medical Center stopped accepting Cigna's MA plans in 2023 and plans to discontinue Aetna and Humana in 2024 while continuing contracts with UnitedHealthcare and BCBS.
It's important to note that even if a hospital accepts Medicare Advantage plans, there may be specific rules and limitations within the plan's network. For example, you may need a referral to see a specialist, or your coverage may be limited to certain hospitals, doctors, or healthcare providers within the plan's network. These rules can change annually, but plan members must receive advance notice of any changes before the next enrollment period.
To find out if a particular hospital accepts Medicare Advantage plans, you can use the Medicare.gov Care Compare tool. This tool allows you to search for hospitals, compare search results, and view overall ratings and patient ratings. It is always a good idea to verify whether a hospital participates in your Medicare Advantage plan and understand the specific rules and limitations of your plan.
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Hospitals that don't accept Original Medicare
While the vast majority of hospitals do accept Original Medicare (Parts A and B), there are some that do not. Generally, Veterans Affairs and active military hospitals do not accept Original Medicare as they operate with VA and military benefits. However, there are a few other exceptions to this nationwide. Hospitals that do not accept Original Medicare must follow specific safety and health regulations to participate with Medicare.
To be certain that your local or preferred hospital accepts Original Medicare, you can use the Medicare.gov Health Care Comparison tool. This tool allows you to search for hospitals, doctors, nursing homes, hospice care, long-term facilities, and dialysis centers that accept Medicare. You can also compare search results and view overall ratings, patient ratings, and more. It is important to note that even if you go to a hospital that accepts Medicare, there may still be out-of-pocket costs associated with your visit.
Medicare Advantage Plans, also known as Medicare Part C or MA Plans, are offered by Medicare-approved private insurance companies and must adhere to Medicare regulations. These plans offer additional coverage beyond what Original Medicare provides and may limit your options to a specific network of healthcare providers. To find a hospital that is in your Medicare Advantage Plan network, you can use the Medicare.gov Find a Facility tool to compare hospitals.
In some cases, doctors or other healthcare providers may choose to "opt-out" of Medicare, meaning Medicare will not pay for any items or services received from these providers, except in emergencies. These providers must opt out for a minimum of two years, and every two years they can choose to keep their opt-out status, accept Medicare-approved amounts on a case-by-case basis, or accept assignment. If you choose to receive services from an opt-out provider, you may need to pay upfront or set up a private payment plan with the provider.
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Veterans Affairs and active military hospitals
Veterans Affairs (VA) and active military hospitals do not accept Medicare. Instead, they operate with VA and military benefits. However, VA health benefits can be used alongside other forms of health care coverage, such as private insurance plans, Medicare, Medicaid, or TRICARE.
If you have VA health benefits and qualify for Medicare at age 65, you can be enrolled in both plans simultaneously. The VA strongly encourages veterans without employer-sponsored insurance to sign up for Medicare Parts A and B as soon as they qualify. Having both VA benefits and Medicare gives veterans more choices for their care. For example, with Medicare, veterans can access non-VA hospitals or doctors, which may be useful if the VA loses funding in the future.
TRICARE is a health care program for active-duty and retired service members, their families, and survivors. It can be used alongside Medicare, with Medicare paying its share first, followed by TRICARE. It is important to enrol in Medicare Part B to maintain coverage under TRICARE for Life.
To find a hospital that accepts Medicare, you can use the Medicare.gov Care Compare tool. This tool allows users to search for hospitals, doctors, nursing homes, hospice care, long-term facilities, and dialysis centres that accept Medicare. It also provides overall ratings, patient ratings, and a map feature to help users find the closest hospital.
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Hospitals with excessive prior authorization denial rates
Medicare is accepted at over 7,000 hospitals in the United States, which must meet Medicare's safety and care standards. However, not all hospitals accept Medicare. Generally, the hospitals that do not accept Medicare are Veterans Affairs and active military hospitals because they operate with VA and military benefits instead.
While Medicare Advantage enrollees have access to automatic, external medical reviews of denials, prior authorization denials are a significant concern for patients with Medicaid. In 2023, nearly 50 million prior authorization requests were submitted to Medicare Advantage insurers, of which 3.2 million (6.4%) were denied. The rate of denial varied across insurers, with Centene having the highest denial rate of 13.6%.
In the case of Medicaid, the high number of prior authorization denials, limited oversight of these denials, and restricted access to external medical reviews have raised concerns about access to care. In 2019, 12 out of 115 Medicaid managed care organizations (MCOs) had prior authorization denial rates greater than 25%, which is twice the overall rate. Despite the high number of denials, most State Medicaid agencies do not routinely review the appropriateness of MCO denials of prior authorization requests, and many do not collect and monitor data on these decisions.
The reasons for prior authorization denials vary, including incomplete or incorrect information, non-compliance with payer policies, and lack of medical necessity. To reduce denial rates, it is important to standardize documentation procedures, educate and train staff regularly, and optimize the prior authorization process.
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Hospitals with slow payment from insurers
While Medicare is accepted at over 7,000 hospitals in the United States, there are a few hospitals that do not accept it. Generally, the hospitals that do not accept Medicare are Veterans Affairs and active military hospitals as they operate with VA and military benefits.
Hospitals that accept Medicare must meet certain safety and health regulations, and patients can use the Medicare.gov Health Care Comparison tool to find hospitals, doctors, nursing homes, hospice care, long-term facilities, and dialysis centres that accept Medicare.
Some providers who do not accept Medicare may still accept the Medicare-approved amount for services on a case-by-case basis and are called "non-participating". Medicare won't pay for items or services from providers that opt out of Medicare, except in emergencies.
Hospitals have been struggling to collect payments from commercial insurers, with one in three inpatient claims submitted to commercial insurers in the first quarter of 2023 not being paid for over three months. This issue of delayed payments from insurers has been observed in hospitals such as Montefiore Health System in New York City, Kaiser Foundation Hospitals in Oakland, California, and Edward-Elmhurst, which has contracts with large commercial payers. The slow addition of downside risk to contracts between hospitals and insurers has been noted as a factor contributing to this issue.
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Frequently asked questions
No, not all hospitals accept Medicare. However, the majority of hospitals accept Original Medicare (Parts A and B).
Generally, Veterans Affairs and active military hospitals do not accept Medicare. There are also a few other exceptions across the United States.
Hospitals that opt out of Medicare do so because of the excessive prior authorization denial rates, slow payments from insurers, and the administrative burden.
When hospitals do not accept Medicare, it jeopardizes the hospital's finances and threatens their existence. It also impacts patients, who may have to forego local healthcare and face higher out-of-pocket costs.
You can use the Medicare.gov Care Compare tool to check if a hospital accepts Medicare. This tool allows you to search for hospitals, compare search results, and view overall ratings and patient ratings.
