Today’s PaperBusiness|Private Medicare Plans Often Deny Access to Rehab Care, Analysis Showshttps://www.nytimes.com/2026/06/11/business/medicare-advantage-nursing-homes.htmlShare full articleAdvertisement
Two reports by U.S. investigators reveal how Medicare Advantage is quick to reject requests for short-term nursing home or inpatient services.
Listen · 6:32 min Share full articleTwo reports found that the three major insurers that sell Medicare Advantage plans denied about 13 percent of patients’ requests to go to a skilled nursing facility to recover from surgery or a serious illness.Credit...David Goldman/Associated PressBy Reed Abelson
!function(){if(document.body.classList.contains("gps-show")){var e="1"===new URLSearchParams(window.location.search).get("gps_debug")?function(e,t){console.log("[gps]",e,void 0!==t?t:"")}:function(){},t=document.getElementById("gpsModule"),s=document.getElementById("gpsLink");document.body.classList.contains("gps-lang-es")&&t.setAttribute("aria-label","Añade a The New York Times a tus fuentes preferidas en Google.");var n=t.closest('section[data-testid="inline-interactive"]'),c=n&&n.id||"google-preferred-source",r=t.closest('[data-testid="region"]'),i=r?r.id.replace(/^NYT_/,"").replace(/_REGION$/,""):"body";e("analytics init",{moduleContext:c,moduleRegion:i}),s.addEventListener("click",function(t){try{localStorage.setItem("gps_suppress_module","1"),e("click: suppression set")}catch(e){}var n=t.target.textContent.trim(),r={event_data:{pagetype:"article",type:"click"},module:{context:c,name:"google-preferred-source",region:i,element:{name:"google-cta",label:n,url:s.href}}};e("click: sending analytic",r);try{window.UnifiedTracking.sendAnalytic("moduleInteraction",r),e("click: analytic sent")}catch(e){console.error(e,"gps: failed to send click",r)}}),function(){var t=0;try{t=parseInt(localStorage.getItem("gps_module_impressions"),10)||0,e("read impressions",t)}catch(e){}function s(e){try{return JSON.parse(e.response).data.user.userInfo.entitlements||null}catch(e){return null}}function n(s){if(e("subscriber check: entitlements",s),function(e){return!!Array.isArray(e)&&(e.includes("TPR")||e.includes("HD")||e.includes("MTD")||e.includes("MSD")||e.includes("MM"))}(s))if(t>=10)try{localStorage.setItem("gps_suppress_module","1"),e("subscriber check: subscriber at cap — suppression set")}catch(e){}else e("subscriber check: not yet at cap, currently:",t);else e("subscriber check: not a subscriber, no suppression")}var c=window.userXhrObject;if(c){if(4===c.readyState)return e("subscriber check: XHR already complete"),void n(s(c));e("subscriber check: waiting for XHR"),c.addEventListener("load",function(){n(s(c))})}else e("subscriber check: no userXhrObject found")}()}}()People enrolled in private Medicare Advantage plans have been inappropriately denied admission to a skilled nursing home when leaving the hospital, according to a new analysis by federal investigators.
These private plans, which cover about 35 million older Americans under the federal Medicare program, have drawn sharp criticism for delaying and denying medically necessary care. Federal investigators have previously raised similar concerns about the plans’ tactics.
Insurance companies offering Medicare Advantage plans often require prior authorization before agreeing to cover treatment. The companies say they are reducing the number of procedures requiring prior approval as part of a broad commitment made last year.
Plans are paid a fixed amount to care for patients, so they have a financial incentive to spend less on care. To achieve savings, these plans often deny people expensive specialized inpatient care, like tailored rehabilitation or therapy services, and may instead send them to outpatient facilities or back to their homes, according to the analysis.
Two new reports from the inspector general’s office at the Department of Health and Human Services focused on major insurers — UnitedHealth Group, Humana and CVS Health, the large for-profit companies whose plans cover the bulk of people enrolled in Medicare Advantage. The companies denied about 13 percent of patients’ requests to go to a skilled nursing facility to continue their recovery from surgery or a serious illness, according to the first report. The investigators also raised concerns about whether outside contractors being used by the insurers to decide whether a patient should get more specialized care were being adequately supervised.
“The dominance of a few large insurance companies in Medicare Advantage and the use of contractors to process prior authorization requests means that the policies and performance of just a few companies can impact care for millions of people,” Rosemary Bartholomew, who led the government team, said in an interview.
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