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Medicare Advantage gets a $25 billion raise while seniors struggle with coverage denials.
That’s not a typo.
CMS just announced MA payments will increase 5.06% in 2026, with the effective growth rate jumping from 5.93% to 9.04%.
Meanwhile:
• Prior authorization denials hit record highs
• Network adequacy violations continue unchecked
• Seniors pay more out of pocket than traditional Medicare
• Rural beneficiaries face shrinking provider networks
The math doesn’t add up.
We’re pumping an extra $25 billion into private plans that already consume 54% of all Medicare enrollees. These same plans that OIG found inappropriately denied care to 13% of requests that met Medicare coverage rules.
Here’s what’s particularly striking:
While MA plans get a 9% growth rate boost, physician payments under traditional Medicare only increased 3.26%. Primary care practices serving the most vulnerable barely break even.
The administration talks about reducing waste and improving preventive care. Yet we’re rewarding the very system that creates administrative burden and care barriers.
💭 Consider this paradox:
MA was supposed to save money through managed care efficiency. Instead, it costs taxpayers 6% more per beneficiary than traditional Medicare, according to MedPAC.
Now we’re doubling down with another $25 billion.
The real question isn’t whether MA deserves more funding. It’s whether we’re willing to keep subsidizing a parallel system that profits from denying care while traditional Medicare, which actually covers everything, gets squeezed.
Something has to give. Either we fix the incentive structure or we admit MA has become too big to reform.
What’s your take: Is this investment justified when seniors report worse access to care?
♻️ Repost if Medicare reform needs more than just bigger payments
👉 Follow me, Jonathan Govette, for daily, real-time updates on healthcare technology and business news. LinkedIn Profile: https://www.linkedin.com/in/jonathangovette/
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Author:
CEO/Co-Founder @ Oatmeal Health | AI Lung Cancer Screening | Almost Became a Doctor | Engineer | Follow to Share What I’ve Learned Along the Way
I help patients get the care they need earlier, preventing late-stage cancer.
That’s been the throughline across three companies and almost 20 years in healthcare. At ReferralMD, we fixed broken referral networks so patients didn’t fall through the cracks. At Oatmeal Health, it’s lung cancer: building the diagnostic and screening infrastructure so the 85% of cases caught too late get caught early instead.
Today as CEO of Oatmeal Health, I lead a team embedding AI into radiology workflows to turn routine lung CT scans into reimbursable cancer risk assessments. We partner with FQHCs to reach underserved communities, and with health systems and payers to make early detection economically sustainable. Think HeartFlow or Cleerly, but for lungs.
Between companies, I advised at Techstars and Plug and Play, mentoring founders building in digital health. That experience shaped how I think about what separates companies that ship from companies that stall: distribution, reimbursement, and clinical trust, not just technology.
I’m a CancerX alumnus, a 3x healthcare founder, and someone who believes the biggest problems in cancer aren’t scientific. They’re operational.
We’re hiring mission-driven builders at Oatmeal Health. If you want to work on something that matters, reach out.
When I’m not working, I’m traveling, mentoring, and keeping up with one very energetic husky. 🐾
Substack – The Oatmeal Bite:
Millions of patients get less care because of who they are, where they live, or how they look. I’m fighting to change that. CEO @OatmealHealth, a startup built for the underserved. The Oatmeal Bite: intel for clinicians, investors, and advocates.
Jonathan Govette
CEO of Oatmeal Health
Substack:
https://oatmealhealthjonathangovette.substack.com/
