News: MA patients face disproportionate access barriers compared to traditional Medicare, analysis suggests

In 2022, Medicare Advantage (MA) patients only had access to approximately 50% of the physicians available to traditional Medicare patients living in the same area, according to the American Hospital Association (AHA).

A new KFF analysis examined 4,200 MA plans from 2022, excluding those provided by employers/unions. Within this cohort, the analysts examined network plans “available to traditional Medicare beneficiaries, by county, plan characteristics, and physician specialties,” comparing them with their MA counterparts.

When comparing the two groups, the report found:

• Disparities across counties: “One third (32%) of all Medicare beneficiaries lived in a county where at least one plan had less than one-quarter of physicians available to traditional Medicare beneficiaries and at least one plan included at least two-thirds of physicians available to traditional Medicare beneficiaries.”
• Disparities across regions: “Among the 30 counties with the largest Medicare Advantage enrollment, the share of physicians available to Medicare Advantage enrollees as a share of physicians available to traditional Medicare beneficiaries ranged from an average of 18% in San Diego, CA to an average of 58% in Pima, AZ (Tucson).”
• Disparities across demographics: “In counties where larger shares of the population were people of color, a smaller share of physicians available to traditional Medicare beneficiaries were in-network, on average, than in other counties (37% vs 52%).”
• Disparities across specialties: “Generally, larger shares of outpatient medical and surgical specialists were in plan networks than primary care physicians, with as many as 72% of ophthalmologists available to traditional Medicare beneficiaries in plan networks compared to only 55% of primary care physicians, on average.”

The report found no correlation between the breadth of provider networks and MA plan star ratings.

Editor’s note: To read the AHA coverage, click here. To read the KFF analysis, click here.