Report
  1. Jacobson G, Swoope C, Perry M, and Slosar M. “How are Seniors Choosing and Changing Health Insurance Plans?,” Kaiser Family Foundation, May 2014. Available at: http://www.kff.org/medicare/report/how-are-seniors-choosing-and-changing-health-insurance-plans/.

    ← Return to text

  2. Jacobson G, Damico A, Neuman T, and Gold M. “Medicare Advantage 2017 Spotlight: Enrollment Market Update,” Kaiser Family Foundation, June 2017. Available at: http://www.kff.org/medicare/issue-brief/medicare-advantage-2017-spotlight-enrollment-market-update/.

    ← Return to text

  3. See Centers for Medicare and Medicaid Services, CY2016 MA HSD Provider and Facility Specialties and Network Adequacy Criteria Guidance. Available at: https://www.cms.gov/Medicare/Medicare-Advantage/MedicareAdvantageApps/Downloads/CY2016_MA_HSD_Network_Criteria_Guidance.pdf.

    ← Return to text

  4. A prior analysis found that 16 percent of Medicare Advantage plans had narrow hospital networks, defined as including less than 30 percent of the hospitals in a county. See Jacobson G, Trilling A, Neuman T, Damico A, and Gold M. “Medicare Advantage Hospital Networks: How Much Do They Vary?,” Kaiser Family Foundation, June 2016. Available at: http://www.kff.org/report-section/medicare-advantage-hospital-networks-how-much-do-they-vary-results/.

    ← Return to text

  5. US Government Accountability Office, “Medicare Advantage: Actions Needed to Enhance CMS Oversight of Provider Network Adequacy,” August 2015. Available at: http://www.gao.gov/assets/680/672236.pdf.

    Resneck JS, Quiggle A, Liu M, and Brewster DW. “The Accuracy of Dermatology Network Physician Directories Posted by Medicare Advantage Health Plans in an Era of Narrow Networks,” JAMA Dermatol., October 2014; 150(12):1290-1297. Available at: http://jamanetwork.com/journals/jamadermatology/fullarticle/1919439.

    ← Return to text

  6. Centers for Medicare and Medicaid Services, “Online Provider Directory Review Report,” January 13, 2017. Available at: https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/Downloads/Provider_Directory_Review_Industry_Report_Final_01-13-17.pdf.

    ← Return to text

  7. For a description of the network categories relative to McKinsey & Company’s categories, see the Methods section of Jacobson G, Trilling A, Neuman T, Damico A, and Gold M. “Medicare Advantage Hospital Networks: How Much Do They Vary?,” Kaiser Family Foundation, June 2016. Available at: http://www.kff.org/report-section/medicare-advantage-hospital-networks-how-much-do-they-vary-results/.

    ← Return to text

  8. Polsky D, Cidav Z, and Swanson A. “Marketplace Plans with Narrow Physician Networks Feature Lower Monthly Premiums Than Plans with Larger Networks,” Health Affairs, October 2016. Available at: http://content.healthaffairs.org/content/35/10/1842.abstract.

    ← Return to text

  9. This finding is similar to those in another report discussing physician networks for mental health care in the ACA marketplaces; see Zhu J, Zhang Y, and Polsky D. “Networks In ACA Marketplaces Are Narrower For Mental Health Care Than For Primary Care,” Health Affairs, September 2017. Available at: http://content.healthaffairs.org/content/36/9/1624.abstract.

    ← Return to text

  10. Note that 9 plans in our analysis had no psychiatrists in the directories, and are not included in the ratio analysis. We consider this to be a conservative method in estimating the enrollee burden; if these plans were included, the ratios of enrollees to psychiatrists would be larger.

    ← Return to text

  11. Jacobson G, Damico A, Neuman T, and Gold M. “Medicare Advantage 2017 Spotlight: Enrollment Market Update,” Kaiser Family Foundation, June 2017. Available at: http://www.kff.org/medicare/issue-brief/medicare-advantage-2017-spotlight-enrollment-market-update/.

    ← Return to text

  12. Among plans offered in the same county by the same insurer, but without a common provider network, HMOs included 48 percent of all physicians in their county, on average, while PPOs included 58 percent of physicians in their county, on average.

    ← Return to text

  13. Dafny L, Hendel I, Marone V, and Ody C. “Narrow Networks On The Health Insurance Marketplaces: Prevalence, Pricing, And The Cost Of Network Breadth,” Health Affairs, September 2017. Available at: http://content.healthaffairs.org/content/36/9/1606.abstract?sid=230cbad6-de5b-4c55-b4aa-26b01641a875.

    ← Return to text

  14. Business Wire, “UnitedHealth Group Signs Definitive Agreement to Acquire Sierra Health Services, Inc.” March 12, 2007. Available at: http://www.businesswire.com/news/home/20070312005513/en/UnitedHealth-Group-Signs-Definitive-Agreement-Acquire-Sierra.

    ← Return to text

  15. A prior analysis of Medicare Advantage hospital networks found that 11 out of 231 plans included hospitals that had been torn down or closed. See Jacobson G, Trilling A, Neuman T, Damico A, and Gold M. “Medicare Advantage Hospital Networks: How Much Do They Vary?,” Kaiser Family Foundation, June 2016. Available at: http://www.kff.org/report-section/medicare-advantage-hospital-networks-how-much-do-they-vary-results/. See also Centers for Medicare and Medicaid Services, “Online Provider Directory Review Report,” January 13, 2017. Available at: https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/Downloads/Provider_Directory_Review_Industry_Report_Final_01-13-17.pdf. See also US Government Accountability Office, “Medicare Advantage: Actions Needed to Enhance CMS Oversight of Provider Network Adequacy,” August 2015. Available at: http://www.gao.gov/assets/680/672236.pdf.

    ← Return to text

  16. Jacobson G, Damico A, Neuman T, and Gold M. “Medicare Advantage 2017 Spotlight: Enrollment Market Update,” Kaiser Family Foundation, June 2017. Available at: http://www.kff.org/medicare/issue-brief/medicare-advantage-2017-spotlight-enrollment-market-update/.

    ← Return to text

  17. A prior analysis found that 16 percent of Medicare Advantage plans had narrow hospital networks, defined as including less than 30 percent of the hospitals in a county. See Jacobson G, Trilling A, Neuman T, Damico A, and Gold M. “Medicare Advantage Hospital Networks: How Much Do They Vary?,” Kaiser Family Foundation, June 2016. Available at: http://www.kff.org/report-section/medicare-advantage-hospital-networks-how-much-do-they-vary-results/.

    ← Return to text

  18. Jacobson G, Griffin S, Neuman T, and Smith K. “Income and Assets of Medicare Beneficiaries, 2016-2035,” Kaiser Family Foundation, April 2017. Available at: http://www.kff.org/medicare/issue-brief/income-and-assets-of-medicare-beneficiaries-2016-2035/.

    ← Return to text

  19. For more information, see Pollitz, K. “Surprise Medical Bills,” Kaiser Family Foundation, March 2016. Available at: http://www.kff.org/private-insurance/issue-brief/surprise-medical-bills/.

    ← Return to text

  20. Jacobson G, Swoope C, Perry M, and Slosar M. “How are Seniors Choosing and Changing Health Insurance Plans?,” Kaiser Family Foundation, May 2014. Available at: http://www.kff.org/medicare/report/how-are-seniors-choosing-and-changing-health-insurance-plans/.

    ← Return to text

  21. Federal Register, Volume 82, No. 137, July 19, 2017. Available at: https://www.gpo.gov/fdsys/pkg/FR-2017-07-19/pdf/2017-15071.pdf.

    ← Return to text

Appendix
  1. See SK&A, Physician Data. Available at: http://www.skainfo.com/databases/physician-data.

    ← Return to text

  2. Cichini, K. “Reading and Text Mining a PDF-File in R,” September 2012. Available at: http://thebiobucket.blogspot.com/2012/09/reading-and-text-mining-pdf-file-in-r.html.

    ← Return to text

  3. See Centers for Medicare and Medicaid Services, Monthly Enrollment by Contract/Plan/State/County. Available at: https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/mcradvpartdenroldata/monthly-enrollment-by-contract-plan-state-county.html.

    ← Return to text

  4. See Centers for Medicare and Medicaid Services, Plan Crosswalks. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MCRAdvPartDEnrolData/Plan-Crosswalks.html.

    ← Return to text