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Lower Reimbursement = Less Providers

I’d like to offer an insider’s perspective on how a provider views Medicare Advantage plans as someone who has handled health insurance claims (both in and out of network) and the enrollment of a medical provider into the Medicare network. 

In my view the most important reason a Medicare Advantage plan is bad is the in network reimbursement.  For providers, being in network could mean a significant reduction in reimbursement for services vs. being out of network.  In addition, Medicare Advantage plans have additional procedural requirements for providers such as pre-authorization. The impact for beneficiaries is simple – the best providers may simply not opt to be in network.  If your Medicare Advantage plan doesn’t have out of network benefits, your choice of providers may be even further limited. 

The reality for providers is that there is a point in which a low reimbursement may make it uneconomical to take certain insurance. 

A good insurance agency can help you navigate the various options when eligible for Medicare.