October 15th marked the first day of the Medicare annual open enrollment period when beneficiaries can revisit their Medicare coverage options. Plan features may change from year to year, as may the health and financial situations of beneficiaries.
One of the plan features that can change from year to year is the network of providers included in each Medicare Advantage plan. (People in traditional Medicare can see any provider that accepts Medicare). KFF focus groups have shown that having access to their doctors as part of a plan’s network is one of Medicare beneficiaries’ top priorities when choosing a Medicare Advantage plan.
For this year’s open enrollment period, the Centers for Medicare & Medicaid Services (CMS) released a new tool on the Medicare Plan Finder that allows beneficiaries to enter up to 5 of their preferred providers to more easily view if their doctors are in a plan’s network. The tool also lets beneficiaries sort available plans in their area by whether a “must-have provider” is in the plan’s network.
In previous years, beneficiaries comparing Medicare Advantage plans would need to go to each plan’s website to determine whether their preferred providers were in the plan’s network. This could be a time consuming and difficult process, comparing provider networks across dozens of plan options that could be in different formats depending on the insurer.
This new feature is not without its problems. For example, when testing the tool, KFF found that many plans still do not list providers and instead prompt the beneficiary to contact the plan for provider information. If a beneficiary selects two or three plans to compare side by side, they can compare premiums and benefits, but not whether their doctors are in-network. Once beneficiaries click on a specific plan for more details, providers can have multiple versions of the same address which can be listed as both in-network and out-of-network, making it difficult to determine whether the provider is in-network at that location. Additionally, if a beneficiary enters a provider name that does not participate in a Medicare Advantage plan in their area, the tool says, “No providers found”, without indicating the doctor might see patients with traditional Medicare, as most doctors participate in the Medicare program.
Recognizing this tool is still a work in progress, CMS encourages beneficiaries to always check with their provider to ensure they participate in any plan the beneficiary is interested in joining. Further, there is a new, temporary Special Enrollment Period available for people who base their coverage decisions off of inaccurate provider directory information in the Medicare Plan Finder.
While most Medicare beneficiaries say they value having their doctors in-network, few compare plans each year and many do not use Medicare’s information resources, including the Medicare.gov website. However, among beneficiaries who do use the Medicare Plan Finder, this search function could be a helpful tool for checking whether their doctors are in-network, particularly as this tool is improved over time.