Nebraska Hospitals Warn of Medicare Advantage Impact, Urge Seniors to Review Enrollment Options
Today, Nebraska Hospital Association (NHA) President Jeremy Nordquist joined local hospital leaders and health care advocates to release the 2025 Medicare Advantage Report, highlight the impact of Medicare Advantage (MA) plans on patients and hospitals in Nebraska, and urge seniors to review their options before enrolling or switching plans during this year’s open enrollment period.
The 2025 Medicare Advantage Report is based on the NHA’s 2025 survey of its 92 member hospitals and reveals that a significant majority of hospitals are facing severe challenges with MA plans. MA plans now cover 54% of all Medicare eligible individuals nationwide, a sharp increase from just over a third less than a decade ago. The Congressional Budget Office (CBO) projects that the share of all Medicare beneficiaries enrolled in Medicare Advantage plans will rise to 64% by 2034. This growth, driven by aggressive marketing and the promise of low out-of-pocket costs, is negatively impacting patient access to care and jeopardizing the financial stability of Nebraska hospitals.
Jeremy Nordquist gave a background on the survey and emphasized the impact MA is having on patients and hospitals. “Medicare Advantage plans restrict medically necessary services through prior authorization requirements, issue inappropriate denials, and create an immense administrative burden on the health care system,” said Nordquist. “Our survey results show that increasing Medicare Advantage enrollment is a serious threat to the state’s health care infrastructure, particularly in rural communities. Reimbursement payments from MA plans are significantly less than those from Traditional Medicare for the same services and 89% of Nebraska hospitals say the shift to Medicare Advantage has negatively impacted their financial position.”
Laura Gamble, CEO of Pender Community Hospital in Pender stressed the negative impact of MA for patients. “We have had great difficulty getting Medicare Advantage to approve skilled nursing care, physical therapy, and behavioral health for our patients. When this care is denied, people who live here in town are forced to leave to receive care or, worse, go without the care they need due to the expense and inconvenience.”
According to a 2024 Senate investigative report, MA plans deny post-acute care at significantly higher rates than Traditional Medicare. These denials, often using AI-driven prior authorization, lead to delayed or premature discharge from hospitals and a reduced ability for patients to access necessary skilled nursing, rehabilitation, or home health services, resulting in poorer health outcomes and increased costs for seniors. Over 90% of Nebraska hospitals find it more difficult to get post-acute care approved for Medicare Advantage patients than Traditional Medicare patients.
Neil Hilton, CEO of Perkins County Health Services in Grant noted that his facility has decided to no longer contract with Medicare Advantage plans altogether. “Growing Medicare Advantage enrollment directly threatens access to care for Grant and our surrounding communities in rural Nebraska. It’s setting a trap for our patients,” he said. “Every senior needs to ask, does your health care plan make you wait for care or deny it?”
Medicare Advantage plans deny care more often than traditional Medicare and can delay your treatment when you need it most. A staggering 98% of hospitals believe prior authorization requirements by MA plans negatively impact clinical care by delaying necessary treatment.
Ivan Mitchell, CEO of Great Plains Health in North Platte discussed the positive results of having stopped accepting Medicare Advantage plans completely at the beginning of this year. “Prior authorization burdens and care denials were bottlenecking our hospital operations and negatively impacting patient care,” he said. “Since ending our participation with Medicare Advantage, our productivity and patient experience is up, and our administrative burdens and care denials are down.”
Hospitals are spending more time and money fighting insurance companies, time that could be spent on patient care. In fact, 93% of hospitals report increased costs just to comply with MA policies and 91% of Nebraska providers feel that the administrative requirements of Medicare Advantage plans contribute to physician and staff burnout.
Jed Hansen, Executive Director of the Nebraska Rural Health Association focused on how Medicare Advantage challenges the future of critical access hospitals due to lower reimbursement rates, slower or denied payments, and increased administrative burdens. “We need policymakers to stand up for patients and providers by demanding Medicare Advantage plans follow the same rules as Traditional Medicare. It’s time for true oversight and accountability.”
Speakers reiterated the need for policy changes for MA plans including reforming prior authorization policies, requiring timely approvals and payments and aligning reimbursement to reflect the cost of care, as well as additional federal oversight and accountability for the program. Seniors should know the facts about Medicare Advantage and consult with their health care provider before enrolling or switching plans during open enrollment this fall.