Oct 17

Medicare Guide 2017: Check for providers in ‘narrow networks’


Fewer than half of all doctors in Multnomah County and other U.S. metropolitan areas are covered by privately run Medicare Advantage plans, a new study has found.

The Kaiser Family Foundation, an independent health policy research center, found that more than 1 in 3 enrollees in private Medicare Advantage plans had access to “narrow networks” comprising less than 30 percent of the physicians and specialists in their areas.

The findings underscore how important it is that seniors ensure their doctors and care centers are included in their plan’s preferred network. Enrollees who go to out-of-network providers either pay more for their care or get no help from their plan.

Yet that task isn’t simple. Network sizes are not prominently advertised by insurers or the government, and provider directors can change at any time, experts say.

“Most of the provider directories are hundreds of pages, and some are organized differently,” said study co-author Gretchen Jacobson, associate health policy director at the foundation in Washington, D.C. “Even some broad network plans had relatively few physicians in specialties.”

Insurance broker Drew Shavere, president of Columbia Benefits Group in Wilsonville, recommends clients use online provider directories, which are more up-to-date than printed directories.

“It can be a little cumbersome,” he said. “The more doctors someone has, the more legwork there is. Not all carriers publish a printed directory. The insurance carriers will tell you themselves those are outdated almost as soon as they’re printed.”

Medicare Advantage plans offer beneficiaries the chance to get their coverage from private insurers and health organizations. Nationwide, 19 million — or 1 in 3 — seniors do, but in Multnomah County, nearly 60 percent enroll in such plans, one of the highest rates in the country.

The study examined nearly 400 plans in 20 U.S. counties, including 30 plans in Multnomah County. On average, the plans covered 46 percent of the providers in a county. In Multnomah County, they covered 42 percent.

None of Multnomah County’s plans offered a “broad network” covering at least 70 percent of the medical providers in the county, while 1 in 5 plans had narrow networks.

Plans most severely limited access to psychiatrists, cardiothoracic surgeons, neurosurgeons, plastic surgeons and radiation oncologists, the study found. In Multnomah County, plans covered only 29 percent of geriatricians, 34 percent of cancer doctors and surgeons, and 31 percent of physiatrists, who specialize in rehabilitation.

Those results were surprising, Jacobson said, because geriatricians specialize in caring for older people, and physiatrists often help seniors rehabilitate from surgeries, arthritis or broken bones.

The study’s authors suggested that insurers limit access to providers to control costs and quality of care.

The foundation, which isn’t affiliated with Kaiser Permanente, believes the study to be the first of its kind to assess the size and makeup of physician networks in Medicare Advantage plans. Experts say networks have been contracting in recent years, but the study only looked at network sizes in 2015.

Article Courtesy of Brent Hunsberger of The Oregonian