Medicare Advantage (“MA”) plans now cover over half of all Medicare beneficiaries nationwide.
Enrollment in these private plans has grown rapidly, especially in rural areas—rising from 11% in 2010 to 40% in 2023. This growth has had significant effects on rural hospitals, including those like Stafford County Hospital that operate as federally designated Critical Access Hospitals (CAHs).
Under traditional, government-administered Medicare, CAHs receive enhanced reimbursement rates to help offset the challenges of serving low-volume, rural communities.
Medicare Advantage plans, however, negotiate their own payment rates with hospitals. These rates are often lower than traditional Medicare reimbursement levels, which can strain the financial stability of small hospitals. Since 2010, more than 150 critical access hospitals nationwide have closed completely or in part, with inadequate reimbursement being a major contributing factor.
Some rural hospitals have chosen not to contract with certain Medicare Advantage plans due to lower reimbursement rates, delayed or denied payments, and increased administrative burdens. When a rural hospital closes, the effects ripple across the entire community—impacting not only health-care access but also employment, local income, and population stability.
What Medicare Advantage Means for Patients
Medicare Advantage plans can offer valuable additional benefits, such as gym memberships, vision or dental coverage, and home safety equipment.
However, beneficiaries should also be aware of potential trade-offs. Most MA plans limit care to a specific network of providers, meaning that patients may face higher costs if they seek care outside their plan’s network. In rural areas, where provider options are already limited, this can force patients to travel long distances or see unfamiliar providers.
In addition, many Medicare Advantage plans require “prior authorization” before covering certain tests, treatments, or hospitalizations.
A recent government report found that these prior authorization processes have sometimes delayed or denied access to medically necessary care—even when the services met Medicare’s coverage criteria.
Medicare Advantage Marketing Practices
Medicare beneficiaries also report frequent and sometimes confusing marketing outreach during open enrollment periods.
Surveys show that nearly all individuals aged 65 and older receive at least one marketing message per week, and two in five receive seven or more. A U.S. Senate committee report found that some marketing tactics have been misleading—ranging from deceptive mailings to unauthorized plan enrollments.
Beneficiaries who believe they were misled or enrolled in a plan without consent can contact Medicare directly at 1-800-MEDICARE (1-800-633-4227) to learn about their options, which may include switching to a different plan immediately.
Submitted by the Stafford County Hospital
