Most Medicare Advantage Enrollees Sacrifice Access to Wide Network of Medicare Providers

Medicare Open Enrollment is currently underway and runs until December 7. During this period, people with Medicare can make changes to their Medicare coverage like going from Original Medicare to Medicare Advantage—or vice versa—or switching to new Medicare Advantage or Part D plans.

Don’t Forget Networks

Choosing between Original Medicare and Medicare Advantage can be complex. One aspect that can be easily overlooked is the importance of networks. With Original Medicare, enrollees can see any provider and use any facility that accepts Medicare (which includes both participating and non-participating providers). Enrollees in most Medicare Advantage plans are limited to seeing in-network providers if they want to avoid extra costs.

How Extensive Are Provider Networks?

A recent KFF analysis found that Medicare Advantage enrollees had access to around half (48%) of the providers that Original Medicare enrollees could see in 2022. The breadth of networks varied wildly across counties, from an average of 15% of available providers in Charles County, Maryland to 88% in Redwood, Minnesota.

Potential Enrollees Should Confirm Network Participation Before Enrolling

Importantly, the KFF analysis is based on public plan directories, which are notoriously inaccurate. Initial searches on the online Medicare Plan Finder (MPF) tool can help identify whether preferred providers contract with available plans. But directory information on Plan Finder does not include all plans and, like other directories, can also be inaccurate.

Directory information on Plan Finder does not include all plans and, like other directories, can also be inaccurate.

In addition to known network issues, plans may also disguise network inadequacy using “ghost networks,” where plans hide the small number of in-network providers by including inactive providers.

Together, these network issues mean Medicare Advantage enrollees have less choice of provider than Original Medicare enrollees and may encounter issues when trying to access care.

Because of these inaccuracies, Medicare Rights always recommends potential enrollees contact plans or providers directly to double-check what providers or facilities are in-network.

Some Help for Those Misled by Medicare Plan Finder

Those who make a bad enrollment decision based on Plan Finder’s inaccurate directories should be able to switch to a new plan using a temporary “Special Election Period for Incorrect Medicare Plan Finder Medicare Advantage (MA) Provider Directory Information.” This SEP will offer relief for people who trust the MPF directory information to choose a plan but later discover the directory was wrong.

This temporary SEP will be available to individuals who made MA enrollments with effective dates of 1/1/26 through 12/1/26.

To qualify for the SEP, individuals must:

Rely on MPF provider directory information,

Enroll in an MA plan through MPF,

Within 3 months of coverage starting, discover that their preferred provider was not actually in the MA plan’s provider network, and

Call 1-800-MEDICARE for help.

People using the SEP will be able to switch to a new MA plan or to Original Medicare (adding a Part D plan if necessary).