Aetna’s New Medicare Advantage Inpatient Policy and Its Impact on Hospitals and Patients

FOR IMMEDIATE RELEASE

Nationwide revenue cycle solutions provider helps hospitals navigate the complexities of clinical revenue cycle management.  

Tampa, Fla. – [August 14, 2025] 

Beginning November 15, 2025, Aetna will implement a New Medicare Advantage Inpatient Policy.

What Hospitals Need to Know

What’s Changing

Aetna will implement a “level of severity inpatient payment policy” that changes how urgent and emergent inpatient claims are paid:

Why It Matters

Our Assessment

This policy avoids issuing formal denials by reclassifying coverage decisions as payment adjustments. This will prevent hospitals from appealing through traditional medical necessity review channels — undermining revenue integrity and patient protections.

What Hospitals Should Do Now

Review Aetna Contracts
Examine language around payment adjustments, denials, and severity-based rates.
Amend Contracts
Require payor adherence to CMS regulations as outlined in the CMS Medicare Advantage and Part D Final Rule 4201-F.
Require formal denials for any inpatient stays paid at a reduced rate. Define and limit payor adjustment authority.
Contact Aetna
Reach out to your payor representative and voice your concerns.
Advocate
Work with AHA (American Hospital Association), CMS, and state regulators to equate “severity” with “medical necessity” for regulatory oversight.
Educate Patients
Notify Aetna MA beneficiaries about potential financial impacts and appeal rights.
Encourage Aetna MA beneficiaries to file a complaint with CMS if patient rights are compromised.

Key Takeaway

If left unchallenged, this policy could set a precedent for Medicare Advantage plans to unilaterally reduce payments without transparency, eroding clinical authority and hospital sustainability.

We’ve prepared an overview detailing what this means for your hospital, your contracts, and your patients — and the steps you can take now.