There are two paths that older Americans can take to secure health care insurance: traditional Medicare or a private Medicare Advantage plan.

Offering extra benefits and low monthly premiums, the lower upfront costs of Medicare Advantage plans can be appealing. But critics say choosing Medicare Advantage, which is seeing increased enrollment, can come with financial and health risks for many older Americans.

Jeremy Nordquist, president of the Nebraska Hospital Association, is wary of Medicare Advantage.

“With a lot of Medicare Advantage plans, you’re taking more of a financial risk,” Nordquist said. “You may pay less up front, but you’re taking a bigger financial risk as you age and move forward.”

Nordquist said private insurance companies, including Medicare Advantage plan providers, typically require approval before certain medical services are provided and covered. This can take time, and doctors and insurers don’t always agree. Nordquist said prior authorization procedures can delay timely access to care.

Around 2.8 million people across Nebraska, Iowa, Kansas and Missouri are on Medicare Advantage plans this year. Nationwide, 62 million people are eligible for Medicare Advantage. About 36 million are using it.

In a 2025 Nebraska Hospital Association survey, 83% of member hospitals reported care was denied to their Medicare Advantage patients. A majority of member hospitals also reported negative financial consequences related to dealing with Medicare Advantage companies, such as lost time for medical staff or low reimbursement rates.

Nordquist said seniors can also be stuck in the hospital when plans don’t cover skilled nursing or post-acute care.

About half of the Nebraska Hospital Association’s member hospitals no longer contract with certain Medicare Advantage plan providers. Around 10% of member hospitals – all in rural areas – no longer accept any Medicare Advantage plans.

“We’ve heard so many horror stories,” Nordquist said. “One that really sticks out to me was a cancer patient. It took the doctor seven months – the doctor knew, in their medical judgment, this service was medically necessary for the patient – seven months to get a cancer patient the treatment they needed, because the insurance company and Medicare-Advantage-plan-slash-insurance-company continued to deny that coverage.”

Providers also need to be “in network” with the Medicare Advantage plan, which could create a mismatch between an enrollee’s preferred providers and the plan’s covered providers. Most health systems accept traditional Medicare, giving those beneficiaries a larger pool of providers to choose from.

Nordquist said Medicare Advantage is better for seniors with few health issues.

“If you don’t think you’re going to need health care – great,” Nordquist said. “But very few seniors are healthy enough to avoid that, so they need to know these challenges up front.”

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