Rural hospital leaders are questioning whether they can continue to afford to do business with Medicare Advantage companies, and some say the only way to maintain services and protect patients is to end their contracts with the private insurers.

Medicare "Participants can enroll in traditional, government-run Medicare or in a Medicare Advantage plan run by a private insurance company."

But in recent years, average Medicare Advantage reimbursements to rural hospitals were about 90% of what traditional Medicare paid, according to a new report from the American Hospital Association. And traditional Medicare already pays hospitals much less than private plans, according to a recent study by Rand Corp., a research nonprofit.

Some rural hospitals in South Dakota, Nebraska, Kansas, Colorado, and Wyoming have dropped contracts with Medicare Advantage companies.

Not a good thing if you live in a rural area and have Medicare Advantage for your health insurance.