Medicare Advantage Network Limitations: Physician Access Compared
- A new Kaiser Family Foundation (KFF) analysis reveals Medicare Advantage enrollees have significantly less access to physicians compared to those in conventional Medicare, raising concerns about choice and...
- With Medicare's annual open enrollment period underway,a new KFF analysis finds that Medicare Advantage enrollees, on average, had access to just under half (48%) of the physicians in...
- The size of medicare Advantage provider networks varies considerably, both across and within counties.
“`html
Medicare Advantage Networks Offer Limited Access to Physicians, KFF Finds
Table of Contents
A new Kaiser Family Foundation (KFF) analysis reveals Medicare Advantage enrollees have significantly less access to physicians compared to those in conventional Medicare, raising concerns about choice and care access during the annual open enrollment period.
Limited Physician Access in Medicare Advantage Plans
With Medicare’s annual open enrollment period underway,a new KFF analysis finds that Medicare Advantage enrollees, on average, had access to just under half (48%) of the physicians in their area who were available to people enrolled in traditional Medicare.
The size of medicare Advantage provider networks varies considerably, both across and within counties. This variability makes it challenging for beneficiaries to determine which plan best suits their needs when making a selection.The analysis highlights that the share of physicians available to Medicare advantage enrollees differs by specialty. Larger proportions of outpatient medical and surgical specialists are typically included in medicare Advantage networks compared to primary care physicians.
Prior KFF research indicates that beneficiaries place a high value on the ability to choose their own doctors. However, the majority – nearly 69 million of the nation’s Medicare beneficiaries – do not compare coverage options or switch plans.
New CMS Tool Aims to Improve Network Openness
Recognizing the challenges beneficiaries face, the Centers for Medicare & Medicaid Services (CMS) has introduced a new feature within the online Medicare Plan Finder. this tool allows beneficiaries to input up to five preferred providers to easily determine if they are included in a plan’s network. Users can now sort plans by whether a “must-have provider” is in-network.
The Medicare open enrollment period began on October 15 and continues through December 7, providing beneficiaries ample time to review their options and make informed decisions.
Understanding the Differences: Traditional Medicare vs.Medicare Advantage
Traditional Medicare (Parts A and B) generally allows beneficiaries to see any doctor who accepts Medicare. Medicare Advantage (Part C) plans, offered by private insurance companies, typically require beneficiaries to use providers within the plan’s network. While some plans offer out-of-network coverage, it frequently enough comes with higher costs.