The number of beneficiaries in Medicare Advantage plans has been revealed to be a disadvantage and it is only about half the amount of doctors available under Medicare, according to the analysis by KFF. This is the main point of the KFF report and it says that at least 48% of all doctors are available to the average Medicare Advantage enrollee.

Restrictions to some doctors, hospitals, and other health care providers confirm such a situation. These restrictions are the result of the way insurers create their provider networks to control costs and usage.

Network modifications can be frustrating for the patients, mainly when they lose their favorite doctors or hospitals because they are no longer in-network.

The Study Behind the Numbers

Researchers from KFF went through the Medicare Advantage provider directories of 2022 from coast to coast. The number of physicians in these plans was compared to the total number of doctors who were paid for treating traditional Medicare patients. The study looked for variations by county, plan type, and physician specialty.

The numbers were alarming. 20% of Medicare Advantage patients having the strictest networks had access to a total of 30% of the doctors under the Medicare plan. On the other hand, the least restricted 20% of beneficiaries could choose from more than 70% of the available physicians.

Wide Variation Across Counties and Specialties

The provider network size was found to be inconsistent in terms of access only at the county level but also within the same county. Such inconsistency complicates the situation for the beneficiaries in making the decision which plan would provide the easiest access to the healthcare providers they like the most.

A different but important conclusion was that specialty had a significant role in determining access to care. Outpatient medical and surgical specialists faced a lower barrier in getting into the networks of Medicare Advantage than primary care physicians. This could be a negative aspect for patients who rely on establishing and maintaining continuity in primary care relationships.

Why Patients Rarely Switch Plans

KFF studies have previously found that Medicare beneficiaries often prefer being able to see any doctor they like. Nonetheless, the fact remains that, during the open enrollment period, the vast majority of the nearly 69 million U.S. beneficiaries do not compare their options or switch plans.

This leads to a situation where many are still oblivious to the fact that their provider networks are very restrictive until they require medical attention.

A New Tool to Help Beneficiaries Choose Wisely

In order to resolve this issue, the Centers for Medicare & Medicaid Services (CMS) have declared the addition of a new faciilty to the online Medicare Plan Finder. The system now allows beneficiaries to input up to five of their preferred doctors and see if they are part of any plan’s network. Also, they can filter through the available plans based on whether their “critical providers” are present in that plan.

The Medicare open enrollment period started on October 15 and will last until December 7, which gives beneficiaries enough time to analyze their options and confirm that their preferred doctors are accessible.