'This is an overlooked catastrophe': Why do so many hospitals not accept Medicare Advantage for cancer patients?

By Quentin Fottrell

 'Insurers have pushed certain cancer-care centers out of network before the end of the calendar or policy year' 

 "It becomes extremely difficult to switch to Original Medicare with the hope of obtaining a Medigap policy." (Photo subject is a model.) 

 Dear Quentin, 

 This is a growing crisis for America's seniors. 

 I am learning from bitter firsthand experience that there is an underreported but devastating contraction in cancer-care providers accepting Medicare Advantage plans, and this issue is not confined to my home state of Florida. Many major hospitals do not accept Medicare Advantage. 

 If someone is diagnosed with cancer after a one-year "trial period," it becomes extremely difficult to switch to Original Medicare with the hope of obtaining a Medigap policy. Medigap applications are medically underwritten and often rejected due to a now pre-existing cancer diagnosis. 

 Compounding the issue, insurers have pushed certain cancer-care centers out of network. This makes it immensely difficult for patients to secure new coverage and avoid interruptions in their cancer treatment. (This has happened to me twice within the past six months.) 

 Although these insurers often state that patients can apply for continuity of care, the process can be nearly impossible to navigate. Patients struggle to find the correct channel to request the necessary forms, and in some cases insurers insist on sending forms by U.S. mail. 

 This is an overlooked catastrophe for America's seniors. 

 Cancer Patient on Medicare Advantage 

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 You are outlining structural problems - re-enroling for Medigap policies - and systemic challenges - hospitals that pick and choose the kind of coverage they choose to accept. 

 Dear Patient, 

 Your tenacity and spirit is noted and appreciated. 

 There are two challenges outlined in your letter. You are outlining structural problems - re-enrolling for Medigap (supplemental) policies - and systemic challenges - hospitals allegedly picking and choosing the kind of coverage they choose to accept. 

 Original Medicare is the government-run, fee-for-service program (Parts A and B) accepted by most healthcare providers. Medicare Advantage (Part C) is offered by private insurers and bundle hospital, medical and prescription-drug coverage (Parts A, B and often D). 

 About the latter: Many major cancer centers - I won't name them in this column, as it's about the system rather than one hospital - either do not accept most Medicare Advantage plans or are very selective, leaving patients like you with limited access to premier cancer care. They must be "in-network" for full coverage. 

 Many major cancer centers either do not accept most Medicare Advantage plans or are very selective. 

 This JAMA Network study published last year confirms your concerns. The research found that patients enrolled in Medicare Advantage are less likely than those on traditional Medicare to undergo cancer surgery at high-quality hospitals. 

 Researchers analyzed data from over 567,000 patients who had major cancer surgeries between 2016 and 2022 and ranked hospitals based on outcomes such as 30-day mortality rates. Traditional Medicare patients were more likely to travel farther to top-performing centers. 

 Fewer Medicare Advantage patients had complex procedures - like pancreatic-cancer surgeries - at top-tier centers, likely due to limited provider networks in these plans. The conclusion was brutal: Medicare Advantage plan networks "may limit access to optimal surgical care." 

 Difficulty signing up for Medigap 

 Regarding the structural problem: When a patient decides to leave a Medicare Advantage plan and return to Original Medicare, as you say, they typically need a Medigap (supplemental) policy to help cover out-of-pocket expenses such as deductibles and coinsurance. 

 Stick to the Medigap open-enrollment period - a one-time, six-month period that starts the first month a person is 65 or older and they have Medicare Part B. During this window, a health insurer cannot refuse to sell a Medigap policy, and policies must be offered at preferred rates. 

 Outside of certain limited enrollment windows, Medigap insurers can use medical underwriting to assess a patient's health risk, which involves reviewing medical history; questionnaires; and, in some cases, exams to determine premiums. 

 Outside of enrollment windows, Medigap insurers can use medical underwriting to assess a patient's health risk. 

 Insurers may deny coverage entirely, charge significantly higher premiums, or refuse to cover costs related to the condition. As a result, many people who become seriously ill after enrolling in Medicare Advantage are trapped between a rock and a hard place. 

 And while you may technically be able to switch back to Original Medicare, doing so without Medigap coverage can, as you found out, leave you exposed to substantial out-of-pocket costs, making the switch financially difficult or even unfeasible. 

 And now a warning: Patients under 65 who are eligible for Medicare due to permanent long-term disabilities have fewer protections. Medigap insurers may deny coverage for them completely because federal consumer protections for Medigap policies do not apply to beneficiaries under age 65. 

 Why hospitals reject Medicare Advantage 

 More than 35 million American seniors - roughly half of all Medicare beneficiaries - are enrolled in Medicare Advantage plans, says Susan Reilly, vice president of communications at Better Medicare Alliance in Washington, D.C. 

 "Medicare Advantage reduces annual out-of-pocket costs and premiums for cancer patients and survivors by more than $2,000 compared to traditional Medicare," she says, "that's a meaningful difference for people managing a serious illness." 

 An increasing number of medical centers are, as you say, turning away Medicare Advantage plans for cancer treatment because, experts say, the reimbursement rates are too low to cover the cost of care, in addition to the complex authorization process. 

 For some centers, reimbursement rates are too low to cover such care and the authorization process can be onerous. 

 Consequently, these managed-care plans frequently limit access to specialized, high-cost cancer centers, leading hospitals to favor traditional Medicare which, in theory, helps them remain (more) profitable and cater to patients with private healthcare plans. 

 Frank L. Beaman, the chief executive officer of Faith Community Health System in Jacksboro, Texas, which provides healthcare services to people in rural areas, says Medicare Advantage plans are designed to keep costs down "by limiting the care they pay for." 

 "Even if your plan says it'll cover 15 visits, your doctor still has to jump through hoops to get approval. They have to prove why the care is necessary and explain everything to someone who doesn't know you or your medical history," Beaman wrote in a 2025 op-ed. 

 Don't take 'no' for an answer 

 Medicare Advantage plans, as private alternatives to Original Medicare, are legally mandated to cover all services provided by Medicare Parts A and B. And yet only a tiny fraction (less than 10% according to some studies) are appealed after receiving a refusal. 

 A spokesperson for AHIP, formerly America's Health Insurance Plans, says contract terminations  are scrutinized by regulatory authorities. "The Centers for Medicare & Medicaid Services audits plans to ensure they meet Medicaid Advantage program rules, including network adequacy." 

 Data from KFF, The Kaiser Family Foundation, shows that of those few appeals against Medicare Advantage denials, roughly 82% were overturned, which goes some way in offering insight into the accuracy and legitimacy of decisions declining care. 

 KFF data shows that of the few appeals against Medicare Advantage denials, roughly 82% were overturned. 

 The reason for the low rate of approval? Nearly all Medicare Advantage enrollees face prior authorization requirements for high-cost services like inpatient stays, skilled nursing and chemotherapy, KFF says. Delaying/denying care is one way for insurers to control costs. 

 Even if you are within the first year of a new Medicare Advantage plan - also known as the "trial period" or first-year disenrollment window - switching back to Original Medicare may not guarantee Medigap coverage if the open-enrollment period has passed. 

 However, federal law does not require a Medigap open-enrollment period for Medicare enrollees under 65, including disabled beneficiaries. Younger Medicare enrollees may face stricter rules and are not guaranteed Medigap coverage, especially those with pre-existing conditions. 

 A "no" to coverage is far from the final word. 

 Related: 'This is a first-world problem': I can't roll over my $800,000 401(k) from my prior employer. What did I do wrong? 

 More columns from Quentin Fottrell: 

 'We're living the simple life': I was a fisherman and my wife was a nurse. We retired with $6 million. Here's how we did it. 

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