While enrollment in Medicare Advantage has increased over time and allows payers to offer extra benefits to beneficiaries, the program may be contributing to barriers and disruptions to care according to a report released by KFF Oct. 27.
The report examines the share of physicians available to Medicare Advantage enrolees as a share of physicians available to traditional Medicare beneficiaries by county, plan characteristics and physician specialties using 2022 MA provider directories.
Here are 10 takeaways from the report:
1. The analysis found a wide variation in network breadth across MA plans. Compared with traditional Medicare, the size of an MA plan’s network did not necessarily indicate whether it included enough physicians with the correct expertise and availability for patients. However, smaller networks increase the chances that enrollees might pay more by going out of network for care or experience other disruptions.
2. MA enrollees were in a plan that included 48% of all physicians available to traditional Medicare beneficiaries in 2022, on average. Narrower networks may also be disruptive for patients who need to switch physicians or sites of care to stay in-network.
3. For the fifth of MA enrollees in plans with the narrowest networks, two out of every three physicians available to traditional Medicare beneficiaries were out-of-network.
4. On the other end of the spectrum, for the one-fifth of MA enrollees in plans with the broadest networks, fewer than one-third of physicians available to traditional Medicare beneficiaries were out of their plan’s network.
5. Among the 30 counties with the largest MA enrollment, the share of physicians available to those enrollees as a share of physicians available to traditional Medicare beneficiaries ranged from 18% in San Diego, Calif., to 58% in Pima, Ariz. According to KFF, this variation means that some MA enrollees have more choice over their providers than others.
6. In counties where a larger share of the population were people of color, 37% of physicians available to traditional Medicare beneficiaries were in-network, compared with 52% in other counties.
7. One third, or 32% of all Medicare beneficiaries lived in a county where at least one plan had less than one-quarter of physicians available to traditional Medicare beneficiaries and at least one plan included at least two-thirds of physicians available to traditional Medicare beneficiaries. However, the report notes that these variations are challenging for beneficiaries to decipher and not obvious when potential enrollees are comparing their Medicare coverage options.
8. The share of physicians available to MA enrollees varied by specialty. Larger shares of outpatient and surgical specialists were in plan networks than primary care physicians, generally speaking, with as many as 72% of ophthalmologists available to traditional Medicare beneficiaries in plan networks compared to only 55% of primary care physicians, on average.
9. MA plan star quality ratings were not correlated with the breadth of the physician network.
10. While star ratings were intended to help beneficiaries choose a plan that best meets their needs, the researchers not that they do not convey the information needed for potential enrollees whose top priority is the breadth of the provider network.
