Medicare Advantage enrollees have less access to doctors: Study
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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 in 2022, a new KFF analysis finds.
Why it matters: While private Medicare plans cap out-of-pocket costs and offer extra benefits, they can also restrict enrollees' choice of physicians and other providers.
- Congress has increased scrutiny of provider networks in recent years with additional provider directory requirements and proposals to expand access. Medicare administrators have also rolled out new tools to help beneficiaries learn if preferred providers are in a plan's network.
What they found: KFF says the one-fifth of Medicare Advantage enrollees in plans with the narrowest networks had in-network access to about one-third of all physicians who were available to people in traditional Medicare.
- On the other side, the one-fifth of MA enrollees in plans with the broadest networks had access to more than two-thirds of physicians available to beneficiaries in traditional Medicare.
- There are bigger shares of outpatient specialists and surgeons in MA insurer networks than primary care physicians.
- Provider networks can vary widely, even within the same counties, making it harder for some beneficiaries to select an option that's best for them.
What we're watching: Open enrollment for the MA plans that now cover more than half of seniors began this month, with the number of plans offered down in 35 states.
- The Centers for Medicare and Medicaid Services estimates that about 51% of all Medicare beneficiaries will enroll in Medicare Advantage plans next year.
- More than 80% of MA enrollees will have the same or lower monthly premium next year if they remain in the same plan, the Trump administration said.
