Why Some Older Adults Struggle to Get the Care They Need After a Hospital Stay

There’s a hidden cost to Medicare Advantage plans that many people don’t see until they need extra care after a hospital stay. Private insurers often say no to requests for rehabilitation or long-term care, leaving older adults in a tough spot. More than half of all requests for these services get rejected by big insurance companies like CVS Health/Aetna, Humana, and UnitedHealth Group. That’s a big problem when someone is recovering from a serious health issue but can’t go home yet. Behind the scenes, these insurance companies use a system called "prior authorization" to approve or deny care requests. The goal? Save money. But critics say this system often prevents people from getting the help they truly need. Post-hospital care isn’t cheap—long-term care hospitals cost around $49, 000 on average, while rehab centers charge about $24, 000. Skilled nursing facilities are less expensive but still add up to $16, 000. Some insurers may deny costlier options even when patients clearly need them.When care gets denied, families feel the pressure. Reports show that older adults and their loved ones often have to fight appeals just to get coverage approved. Even when they win, the process is stressful and time-consuming. Some families end up paying out of pocket because they can’t wait for insurance to approve help. Rising costs for home care and assisted living—up nearly 50% in five years—make this even harder for middle-class families already stretched thin. Insurance companies argue that prior authorization keeps costs down and ensures patients get the right care. But critics say the system sometimes goes too far, leaving people stranded without the support they need. The debate isn’t just about money—it’s about whether older adults can heal properly after a hospital stay.