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Breaking News: Government Finds Medicare Advantage Plan Networks Are Misleading & Inaccurate

Nearly half of Medicare Advantage Plans found to have incorrect listings of doctors in Medicare directory —
even listing doctors who have passed away!

The Centers for Medicare & Medicaid Services (CMS), the government organization which oversees Medicare plans and their administration, just announced a new study which found gross inaccuracies in Medicare Advantage plans’ networks of providers.

This shocking announcement – although not so shocking for Medicare Advantage beneficiaries who have suffered the consequences – sadly confirms what the organization, Medicare Rights Center, had long suspected. Medicare Rights Center (MRC) has been encouraging CMS to investigate the coverage network for Medicare Advantage (MA) plans for quite a while. And last week CMS announced in an 11 page report that it completed a seven month investigation in mid 2016, affirming MRC’s fears — nearly half of Medicare Advantage provider directories had incorrect information listed.

“Directories that include locations where a provider does not practice or state that providers are accepting new patients when they are not call into question the adequacy and validity of the Medicare Advantage [plan’s] network as a whole. These inaccuracies can create barriers for members to receive services critical for their health and well-being.


What Issues with Medicare Advantage Did CMS Find?

Medicare Advantage plan beneficiaries have been filing complaints with CMS, resulting in CMS taking action by first investigating MA plans’ dermatologist networks.

Their initial research found that in 12 metropolitan areas, almost 46% of dermatologists listed in Medicare network directories were duplicate listings. To make matters worse, fewer than half of the unique doctors listed had correct contact information, actually accepted the plan, or had available appointments. CMS later followed this study up with a look at Primary Care Providers (PCP), only to find slightly better results.

In February 2016, CMS decided to expand its research to the most common types of doctors: PCPs, Oncologists, Cardiologists, and Ophthalmologists. The study included online directories, which insurance carriers can more easily update in a timely manner.

CMS studied 108 providers from 54 different MA plan provider directories, searching a total of 5832 doctors and hospitals across the nation. CMS found that 47% of Medicare Advantage plans has inaccurate provider directories.

CMS also looked at 11,646 locations listed as accepting MA plans, and found 45% of locations listed in provider directories had incorrect information. They found a variety of issues: providers never having been located at an address listed; incorrect phone numbers; providers not accepting any new patients (even though the directory indicated they were), to name a few.

The most shocking revelation was that some providers listed had retired – or even had passed away – and were still listed on MA plan directories as accepting new patients!

Why Does This Matter?

People who are enrolled in Medicare Advantage plans are oftentimes limited in their choices of doctors and hospitals. Medicare Advantage plans have what are called “Networks” or “Provider Networks”, which are lists of physicians and facilities where they may receive treatment.

If a Medicare Advantage beneficiary chooses to use a provider or facility not in their plan’s network, they will likely have to pay the entire cost of treatment out of their own pocket.

In other words, Medicare Advantage plans greatly limit enrollees’ options, even when you don’t take into consideration this newly discovered inaccurate information.

Network limitations can cause frustration and expensive medical bills, especially in rural areas or in areas where provider networks are not accurate. Furthermore, provider directories can change at any time — in fact, I’ve seen over ⅓ of one local MA insurance company’s network stop accepting the plan in one year! That means thousands of patients had to find new doctors, regardless of the decades’ long relationship with a particular provider and regardless of any outstanding treatments.

What Does This Mean for People on Medicare Advantage?

At the very least, CMS recognizes that incorrect provider directories and limited availability of doctors will lead to frustration and hassle for MA beneficiaries. More troubling, though, is the assumption that this inaccurate information is preventing Seniors from accessing the health care they desperately need.

“Because Medicare Advantage members rely on provider directories to locate an in-network provider, the accuracy of this information is critical.”

The nation’s organization which oversees both Medicare Advantage and Medicare Supplement plans, both of which are options to enhance original Medicare’s coverage, is clearly disturbed by what it discovered. It’s obvious that inaccurate directories can lead to a snowball effect:

If an MA beneficiary is unable to find an accurate location for a provider, they are then unable to schedule an appointment. If the phone number is also inaccurate, as was the case in over 520 locations surveyed, the patient cannot even call to inquire. CMS also found that in 1162 locations studied, the provider listed did not work at any of the multiple locations listed for that provider.

Unfortunately, these errors made by MA companies have undoubtedly lead to barriers in accessing healthcare for countless Seniors and Baby Boomers who are simply attempting to receive the medical care they deserve.

What You Can Do

CMS has made clear that ultimately, it is up to the Medicare Advantage insurance company to ensure that their provider directories are up to date. Outside of these new studies, it doesn’t appear that CMS plans to enforce any sort of additional, regular oversight of MA plan directories.

“Moreover, if [Medicare Advantage plans] had implemented routine oversight of their processes for data validation, errors in the provider directory would have become Apparent.”

In the internet age, refreshing online directories on a daily basis should not be an impossible undertaking!

People already on Medicare Advantage plans may be stuck in their plan for the remainder of the year. However, you may also qualify for a special allowance to come off of your Medicare Advantage plan now to switch to better coverage.  

If you are new to Medicare or will be turning 65 this year, it’s extremely important that you choose the right coverage as soon as possible!

People new to Medicare (turning 65, coming off of a group plan, etc.) have the unique opportunity to enroll in a Medicare Supplement (MediGap) plan during their Initial Enrollment Period without having to answer any questions about their health status. The Initial Enrollment Period to enroll in a MediGap plan begins six months before the month in which your Medicare coverage begins, the month your coverage begins, and the six months following when your coverage begins.

This 13 month period is important to take advantage of. Otherwise, you may have to answer health questions to enroll in a Medicare Supplement plan, which could result in you being denied coverage if you are seriously ill.

Finding an affordable Medicare Supplement is paramount to ensuring you have the most convenient and flexible plan available! Medicare Supplement plans differ from Medicare Advantage plans in many ways:


With the help of a licensed Medicare Agent, finding a MediGap plan that takes away the headaches of dealing with provider networks is simple! Why choose a plan that limits your options and provides false information… when you could have a plan that allows you to see any doctor in the nation, any time?

What Is Being Done to Resolve the Accuracy of Medicare Plan Network Directories?

The CMS has already launched an investigation into an additional 64 Medicare Advantage companies and plans, including newer plans and the most popular plans by enrollment. Nine of these ten top plans were reviewed in the first round, so CMS will hopefully be looking for improvement since last year’s study.

Unfortunately, of the thousands of errors found, CMS only issued formal statements and warnings to several dozen MA plans. We are hopeful that CMS enforces stricter consumer protection protocols, should more discrepancies be found during this second study. After all, CMS needs to protect consumers, too!

In the meantime, it’s highly recommended Medicare beneficiaries choose a Medicare Supplement plan to enhance their coverage. Medicare Supplements have all the benefits with none of the downsides that come along with MAs.

Finding the right Medicare Supplement for you is easy and can be done in just a few minutes with the help of a Licensed Agent!

You deserve the best healthcare available. Don’t get trapped by inaccurate and limiting Medicare Advantage plans! Contact us today and speak to a licensed Medicare agent to help you understand your options: 844-305-6169.

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