Not So Narrow After All: Study Shows Most Medicare Advantage Plans Offer Broad Provider Networks

Screen Shot 2019-06-19 at 11.57.41 AM

The explosive growth of Medicare Advantage (MA) plans in recent years has sparked concerns in some quarters that so-called narrow provider networks may be restricting access to care for some Medicare enrollees.

Narrow networks emerged a decade or so ago and generally refer to provider panels that limit participation to physicians and hospitals willing to meet specific quality benchmarks, while accepting lower reimbursement in anticipation of greater patient volume.

The idea of more closely linking quality and cost is a key concept at the heart of value-based care. However, the implicit trade-off of narrow networks has always been that consumers would have fewer options to choose from when selecting a doctor.

But now a surprising new study supported by the Commonwealth Fund is belaying the notion that most – or even many – MA plans rely on narrow networks. According to the report, plans with narrow networks represent a very small and diminishing percentage of all MA plans. That said, the number of people enrolled in plans with narrow networks remains disproportionately high relative to the number of plans offering them. But that ratio is falling, too.   

Commonwealth researchers used Medicare Part D claims data from 2011 to 2015 to determine how MA primary care physician networks have evolved over time. Here’s what they learned:

  • MA plans with narrow networks dropped from 2.7 percent of all MA offerings in 2011 to 1.8 percent of the total in 2015. In contrast, broad network MA plans increased from 80.1 percent of the total to 82.5 percent over the same period.
  • MA enrollment has steadily shifted from narrow to broad networks, with enrollment in broad network products rising from 54.1 percent in 2011 to 63.9 percent in 2015.
  • Narrow network products are more prevalent in areas with large populations, greater household incomes and higher physician-to-patient ratios. Researchers suggested it may be easier to exclude doctors in urban areas, given that these areas tend to have greater numbers of practicing doctors compared to rural communities.
  • Health maintenance organization (HMO) plans tend to have narrower networks than point-of-service (POS) or preferred provider organization (PPO) plans.
  • Narrow network products are more common in less-concentrated MA markets.

Based on the data, the researchers concluded that fears that narrow networks are restricting access to primary care “may be unfounded.” The report noted that using claims-based data to measure provider networks likely offers a more accurate picture of network composition than a reliance on provider directories.

“Claims-based networks capture where beneficiaries actually receive care; provider directories, which are created by plans, do not account for the fact that some providers may not be accepting patients,” the researchers wrote.

The bottom line, according to researchers: “Despite concerns that the provider networks of Medicare Advantage plans are becoming increasingly restrictive and impeding beneficiaries from getting the care they need, the share of plans with broad primary care networks has increased over time, while the share of those with narrow networks has decreased.”

More market insights about Medicare Advantage plan enrollment trends can be found here.

Share This Story