Hospitals as insurers: the payvider shift reshapes Medicare Advantage

Hospitals that own Medicare Advantage plans—the so-called payviders—now cover about one in six MA enrollees, a shift that can improve care coordination but also risks gaming risk‑adjustment payments and harming competition. Early data show affiliated plans often charge higher premiums and price marks vs. non‑affiliated plans, though some observed benefits include fewer prior authorizations and better care coordination; much remains unknown about the net effects on costs, taxpayer expenditures, and patient access.