11/07/2025
🩺 “Why are Medicare Advantage plans so bad?”
A friend asked me that—and JAMA just gave us the answer.
📊 In 2024 alone:
• 50M prior auths
• 3.2M denials
• 56M claims denied after care
🤖 Many done by AI—with little oversight.
💸 Why? Because MA plans profit when they delay or deny your care.
👩⚕️ The fix? Let neutral third parties, not insurers, decide what’s medically necessary—like in Traditional Medicare.
💭 Could this work? Would it rebuild trust in Medicare?
🎧 Every week on WorkingHealthcare, we unpack what’s really happening inside the $4.9T U.S. healthcare system.
Because we can’t fix what we don’t understand.
https://jamanetwork.com/journals/jama/fullarticle/2835645
This Viewpoint discusses how delegating Medicare Advantage coverage and payment decisions to a third party could limit claim denials and improve access to care.
