Most Medicare Advantage plans establish networks that restrict your access to doctors and hospitals. And, the data show that people in Medicare Advantage plans overall have a greater chance of getting care from lower quality providers than people in traditional Medicare. A new paper by David Meyers et al. in the Journal of General Internal Medicine finds that Medicare Advantage plans with five-star ratings tend to have narrow networks that restrict access to certain types of care considerably.
Here’s what some of the independent research reveals: People enrolled in Medicare Advantage are less likely to receive care from the highest quality hospitals and nursing homes and are more likely to disenroll if they develop a complex condition. Black, Hispanic, and Asian Americans enrolled in Medicare Advantage plans have poorer health outcomes than white Americans. It’s not clear, however, whether this racial disparity stems from the makeup of the Medicare Advantage plan networks.
In their new research, Meyers and his team find a correlation between plans with higher star-ratings and the breadth of their provider networks. They find that the big for-profit health insurers offering Medicare Advantage plans with higher premiums and a large number of enrollees have wider networks. And, they find that Medicare Advantage plans with the highest star ratings tend to have narrow networks.
Furthermore, the researchers find that if you’re in a Medicare Advantage plan, odds are that you’ll have inadequate access to in-network mental and behavioral health providers, cardiologists, psychiatrists, and primary care providers.
Note: Star-ratings do not tell you enough about the quality of a plan to rely on. You can’t don’t know which Medicare Advantage plans give you access to high-quality providers. That’s inexcusable.
The researchers argue specifically for more information to people choosing among Medicare Advantage plans about the breadth of their provider networks and reforms that ensure adequate numbers of mental health providers in Medicare Advantage plan networks.
All said, you can’t possibly look at the available information and choose a Medicare Advantage plan that’s right for you. You don’t know enough about what the Medicare Advantage plan offers or what your future health care needs will be. Only traditional Medicare allows you the freedom to meet those needs when and where you choose.
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