Quality, Scope of Medicare Advantage Plans Varies Widely

As Medicare Advantage becomes increasingly common in the skilled nursing space, consumers may still have trouble determining whether a plan works best for them — or even provides quality coverage with access to a wide variety of physicians and SNF care.

And even if a potential MA enrollee finds a plan that appears to cover visits with a large percentage of local providers, the numbers may not actually indicate the prevalence of specialists that they need, hiding a lack of SNFs, gerontologists, or other providers.

On average, Medicare Advantage plans include just 46% of physicians in any given county across the country, according to a new study conducted by the Kaiser Family Foundation.


Researchers analyzed available MA plans in 20 counties across the United States, including  King County in Washington state, Cook County in Illinois, and Jefferson County in Alabama — the homes of Seattle, Chicago, and Birmingham, respectively. The team at Kaiser then compared the available coverage with the total number of providers in the county to determine how many in each county accepted MA.

The results show a wide range of physician availability for consumers enrolled in MA plans. Most plans consist of what Kaiser termed “medium networks,” or plans that cover anywhere between 30% to 69% of physicians in the county. But 27% of plans fell in the “narrow networks” category, which were accepted at less than 30% of the providers in the county; only 21% of all plans could allow enrollees to see 70% or more of the doctors in their local area.

Furthermore, more than one-third of MA enrollees had “narrow” plans was of 2015, Kaiser found.


The researchers also found fault with the Centers for Medicare & Medicaid Services (CMS) Medicare Plan Finder, which is intended to help consumers research the MA plans available in their areas. Kaiser noted that information on the plan finder is frequently inaccurate, and comparing the plans may be difficult.

“The Medicare Plan Finder also posts an estimate of the total number of providers in the network, but the total includes physicians as well as other providers, such as hospitals, nurses, skilled nursing facilities and laboratory testing sites,” Kaiser noted in its analysis. “This estimate would not be helpful for Medicare beneficiaries who are looking to see if the plans available to them have a narrow or broad physician network.”

Read the full analysis, which includes a variety of charts and graphs breaking down MA availability, at the Kaiser Family Foundation.

Written by Alex Spanko

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