Gothenburg Health is teaming up with the Nebraska Hospital Association (NHA) to help seniors better understand the challenges that can come with Medicare Advantage (MA) plans.

Nationwide, MA plans now cover 54% of all Medicare-eligible individuals, according to the NHA. Many seniors are drawn to these plans by promises of low out-of-pocket costs. However, the NHA is urging Nebraska seniors to carefully review their Medicare enrollment choices this fall.

While Gothenburg Health continues to accept MA plans, the NHA reports that half of Nebraska hospitals are choosing not to contract with certain Medicare Advantage providers due to ongoing issues.

Gothenburg Health’s patient accounting team has seen firsthand the problems MA plans can create, including delays caused by prior authorization requirements and unexpected costs.

“When people are sold these plans, they are told it won’t cost them anything out of pocket. That isn’t always true,” said Jessica Lux, patient accounting representative at Gothenburg Health. “Additionally, many services require prior authorization through Medicare Advantage, and we receive many denials. This is not the case for traditional Medicare plans.”

The NHA reports that 98% of hospitals believe prior authorization requirements under MA plans delay necessary care. A 2024 Senate investigative report cited by the NHA found that MA plans deny post-acute care at significantly higher rates than traditional Medicare. These denials—often made by AI-based systems—can lead to premature hospital discharges and limited access to skilled nursing, rehabilitation, or home health services. The result, according to the report, is poorer health outcomes and higher costs for seniors.

The NHA also warns that insurance agents and brokers are not required to present all coverage options to seniors. Many are paid by insurance companies to enroll individuals in MA plans and receive ongoing compensation as long as the person remains enrolled.

To help seniors make informed decisions, the Nebraska State Health Insurance Assistance Program (SHIP) offers free, unbiased, and personalized counseling on Medicare coverage.

Gothenburg Health and the NHA hope their outreach efforts will empower seniors to choose the coverage that best meets their healthcare needs—without unexpected barriers to care.