Medicare Advantage Plans Often Deny Seniors Access to Special Care, Analysis Shows

People enrolled in private Medicare Advantage plans have been inappropriately denied admission to a skilled nursing home when leaving the hospital, according to a new analysis by federal investigators.

These private plans, which cover about 35 million older Americans under the federal Medicare program, have drawn sharp criticism for delaying and denying medically necessary care. Federal investigators have previously raised similar concerns about the plans’ tactics.

Insurance companies offering Medicare Advantage plans often require prior authorization before agreeing to cover treatment.

Plans are paid a fixed amount to care for patients, so they have a financial incentive to spend less on care. To achieve savings, these plans often deny people expensive specialized inpatient care, like tailored rehabilitation or therapy services, and may instead send them to outpatient facilities or back to their homes, according to the analysis.

Article source: https://www.nytimes.com/2026/06/11/business/medicare-advantage-nursing-homes.html