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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:
Jonathan Govette is a seasoned healthcare and technology executive with more than two decades of experience building, scaling, and advising digital health companies. He is the Co-Founder and CEO of Oatmeal Health, an AI-driven Lung Cancer Screening and Diagnostics company focused on expanding access to early detection for underrepresented populations, particularly patients served by Federally Qualified Health Centers and value-based health plans.
With a background in engineering, product development, and strategic partnerships, Jonathan has founded and led multiple health technology ventures across clinical care delivery, regulated medical software, and AI-enabled diagnostics. His work sits at the intersection of medicine, technology, and health equity, with a consistent focus on translating complex clinical problems into scalable, real-world solutions.
Jonathan has spent much of his professional life dedicated to improving outcomes for marginalized and underserved communities. He has designed and implemented frameworks that align clinical quality, reimbursement, and technology to sustainably advance health equity at scale. This mission is deeply personal and informs his leadership philosophy and long-term vision for healthcare transformation.
In addition to his operating experience, Jonathan is an author and long-time writer in the healthcare domain, with over 20 years of published work covering digital health, medical innovation, and healthcare systems. He is a frequent mentor to early-stage founders and regularly advises startups on product strategy, partnerships, and go-to-market execution in regulated healthcare environments.
Before entering industry full-time, Jonathan nearly pursued a career in medicine with an early path toward cardiothoracic surgery, an experience that continues to shape his clinical perspective and respect for frontline care delivery.
CEO | Oatmeal Health | AI Lung Cancer Startup | Engineer | Writer | Almost Became a Doctor (Cardiac Thoracic Surgeon) | 3x Health Tech Founder | Startup Mentor | Follow to share what I’ve learned along the way.
