Medicare Advantage networks raise patient-provider issues
Regarding the Sept. 28 article “Medicare Advantage plans need better network adequacy oversight: GAO” (ModernHealthcare.com, Sept. 28), I have been following the debate on the changes in Medicare Advantage plans, especially in light of the enactment of the Affordable Care Act. Although data show that the number of private health plans and their enrollees have been increasing over the past few years, I agree that there is a need for more oversight, especially in the context of patient-provider perspective.
In addition to having a network broad enough to cover their medical needs, I believe Medicare beneficiaries should have the right to choose which provider they would like involved in their care. Too often, I hear of patients who have been with the same physician for decades but now have to stop seeing this provider, ending a strong relationship simply because the doctor isn’t part of a plan’s network.
Nowadays, the ratio of HMO versus PPO plans under Medicare Advantage is largely weighted toward HMOs. The PPO premiums are often twice as costly. Thus, beneficiaries often feel forced out of their patient-physician relationship because of their insurance plan.
Medicare Advantage should expand their provider networks, while preferentially including local providers who already have a relationship with the plan’s enrollees. In this scenario, it wouldn’t be necessary to consider whether a provider is taking new patients or not. Also, there should be a rigorous review of the reasons for and implications of terminating an agreement with an already-established provider, keeping the best interests of the patient in mind.
With the growing concerns over the scheduled reduction in payment to Medicare Advantage plans, I am curious to see how this network problem will unfold.
Michael Osnard Master’s in Public Health candidate University of Pittsburgh Graduate School of Public Health