Even Researchers Don’t Know Which Doctors Medicare Advantage Covers

The following originally appeared on The Upshot (copyright 2019, The New York Times Company). I also appeared on page B4 of the print edition on July 15, 2019. 

If you try to use Medicare Advantage, figuring out which doctors are available (and where) can be exceedingly difficult, if not impossible.

Medicare Advantage is the government-subsidized, private alternative to the traditional public Medicare program. It has had strong enrollment growth for years.

That growth has received a boost from the Trump administration, which has sent emails to people using Medicare to promote how much more coverage they could get for less money from private plans. Missing from those emails, however, is a mention of one big limitation of those plans: Many cover far fewer doctors than the traditional program.

That may not be a problem if you can find a plan that includes doctors you prefer, or if you can find covered doctors in convenient locations.

But that isn’t often the case, as government audits of Medicare Advantage plan directories show. The Centers for Medicare and Medicaid Services, which oversees the program, found that nearly half of entries had one of three problems: address errors, incorrect phone numbers, or doctors who were not accepting new patients. In 2017, the Department of Justice reached a settlement with two Medicare Advantage plans over charges of misrepresentation of their networks to regulators.

Other research reveals that Medicare Advantage provider directories are relatively poor sources of information. For example, a study published in the American Journal of Managed Care found that Google was more accurate.

“Directory accuracy is hard,” said the study’s lead author, Michael Adelberg, a former senior Health and Human Services regulator in Washington and now a leader of health care strategy for the Faegre Baker Daniels law firm. “But when a consumer joins a plan to get to a doc in the directory and then cannot, that consumer has a very legitimate beef.”

(I was a co-author on the study, along with Daniel Polsky, a health economist with Johns Hopkins, and Michelle Kitchman Strollo, a vice president and associate director of NORC’s health care department at the University of Chicago.)


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