Medicare Disadvantage: Whose Advantage Are You Buying?

Insurers can discontinue plans, remove physicians and restrict access. Patients deserve to know what they are buying before they need care.

At 65, most Americans qualify for a golden ticket: Medicare. Why would we let them trade away its freedom without explaining the price?

Traditional Medicare lets patients seek care from any physician or hospital that accepts Medicare nationwide. Patients still face premiums and cost sharing, but an insurer’s provider network does not dictate their choices. 

Medicare Advantage puts a private insurer between that patient and those choices. Patients retain their Medicare entitlement, but they accept the plan’s coverage rules and network restrictions.

That is the trade we, as physicians and healthcare executives, need to expose.

The golden ticket is access. Medicare Disadvantage gives an insurer control over it.

Quartz reports that UnitedHealth and Humana will discontinue Medicare Advantage plans covering roughly 1 million people ahead of 2027.

The restrictions reach beyond canceled plans. Reuters reports that UnitedHealthcare and Aetna plan more restrictive provider networks for 2027. Humana will reduce its reach from 85% of U.S. counties to just over 80%.

Patients can lose their plan. Practices can lose their network contracts. A patient who keeps the same insurance card can still lose in-network access to a treating physician.

At The Hirsh Center, UnitedHealthcare’s Dec. 1 termination leaves our patients without a Medicare Advantage option that includes our practice. That is one example of what disappearing choice looks like.

Staying in network does not eliminate the barriers.

In 2024, Medicare Advantage insurers fully or partially denied 4.1 million prior authorization requests. Patients and their representatives appealed just 11.5% of those denials. Insurers reversed 80.7% of the appealed decisions, partially or fully, according to KFF

Additional documentation can change a decision. But the work still lands on our teams: retrieve records, submit appeals, defend treatment and chase approvals.

Physicians spend time justifying care. Employees spend time pursuing permission. Patients spend time waiting.

And Medicare pays more for this arrangement.

MedPAC projects $76 billion in additional Medicare spending on Medicare Advantage in 2026 — 14% more than covering the same beneficiaries through traditional Medicare.

Why should we accept higher public spending alongside restrictions that obstruct our ability to deliver care?

Independent practices cannot sustain unlimited administrative work or contracts that undermine the cost of providing treatment. We need to scrutinize these arrangements and refuse terms that threaten our survival. Signing a contract does not preserve access if its requirements make delivering care unsustainable.

Why do we keep giving insurers control over the care we must deliver?

We also cannot tell patients they can simply reclaim their golden ticket without explaining the complications. Outside protected enrollment opportunities, obtaining a Medigap policy after returning to traditional Medicare may require underwriting; guaranteed issue protections depend on the circumstances.

Physicians and health care executives: Share this information before patients enroll. Medicare’s annual open enrollment runs Oct. 15 through Dec. 7, 2026, for coverage beginning Jan. 1, 2027. Use your practices, professional associations and public platforms to explain what network restrictions and prior authorization mean when someone actually needs treatment.

Encourage patients to call 1-800-MEDICARE (1-800-633-4227) or visit Medicare.gov to review their coverage options before making a decision.

Take documented denials and network disruptions to lawmakers. Demand accountability. Stop leaving the enrollment conversation to the companies selling the plans.

Patients deserve to understand the value of their golden ticket before handing an insurer control over how they use it.