People who need health care in Medicare Advantage too often find that the provider directories they rely on when choosing a Medicare Advantage plan are inaccurate. The Senate Finance Committee is looking to address the problem, and the American Medical Association is cheering it on. The fixes are a step forward but should go a lot further. If Medicare Advantage can’t offer adequate provider networks and accurate directories, why are they in business?
For the last 20 years, insurers have been able to make their Medicare Advantage provider network directories look far more robust than they actually are, misleading enrollees. The Centers for Medicare and Medicaid Services, CMS, does not begin to have the resources to oversee network adequacy in the more than 4,000 Medicare Advantage plans, let alone protect enrollees when CMS identifies networks that are inadequate. So, insurers have every incentive to have narrow networks and to mislead enrollees.
The MA plans must know who’s in their network since they pay these providers. There’s no excuse for inaccurate directories. Moreover, the insurers should not be allowed to deceive people by offering different plans with different networks that people cannot distinguish or discriminate against people with low incomes or communities of color by offering them poorer networks than others.
What’s wrong in the network directories? A lot. The directories often fail to explain where enrollees can see in-network physicians (yes, the same physician can be in-network at one location and out-of-network at another,) or they claim physicians are in-network when they are not; and, if providers are in-network, the directories often don’t indicate that they are not taking new patients. It would be easy to fix the problem with one national government directory that imposed penalties on insurers who did not maintain accurate or complete information. One directory would also make it far easier for people to comparison shop for a Medicare Advantage plan.
CMS proposed a national provider directory a couple of years ago, but it has not gone anywhere to date.
But, the insurers oppose a system that would actually help people make informed choices of Medicare Advantage plans. Many in Congress appear to be right there with the insurers. Senator Ron Wyden, who chairs the Senate Finance Committee is trying to end provider directory errors and protect enrollees. Mike Crapo, the ranking Republican on the Committee, claims he is as well. But, what are they doing?
The Finance Committee approved “The Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023,” legislation. Some of it is now law. The bill requires Medicare Advantage plans to have accurate and updated provider directories. Though Medicare Advantage plans always have been required to have accurate in-network information, the bill would require more verification. The bill would also protect Medicare Advantage enrollees from the costs of inaccurate directories if they had to pay for out-of-network care when they were led to believe care was in-network. Beginning in 2026, enrollees would only be responsible for the in-network copay.
Here’s more from Just Care:
- You still can’t trust Medicare Advantage plan provider directories
- Out-of-network care: Don’t trust your insurer to pay the bills
- If you’re in a Medicare Advantage plan, watch out! Your doctor or hospital might no longer be in-network
- Government proposes national health care provider directory
- The price you pay for a narrow network
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