- Hospital networks vary considerably across Medicare Advantage plans, with nearly a quarter offering broad networks while 16% have narrow networks, a recent report by The Henry J. Kaiser Family Foundation found.
- The report is the first in-depth look at Medicare Advantage networks, drawing on 2015 data from 409 plans, including 307 HMOs and 102 local PPOs.
- Beneficiaries often cite access to specific providers and hospitals as a prime reason they choose one plan over another.
Going out of network can be costly for Medicare Advantage enrollees, so it pays to find a plan with a broad provider network. But not all beneficiaries have access to broad network plans, as the study shows.
Of the Medicare Advantage plan networks KFF studied, 23% were broad, 30% were medium-large, 31% were medium-small, 14% were narrow and 2% were ultra-narrow.
Plan networks typically included about half of the hospitals in their county, and 80% included an academic medical center. However, two in five plans with easy access to an NCI-designated cancer center did not include the center in their networks, the report says.
The 409 plans covered beneficiaries in 20 diverse counties nationwide, accounting for roughly one in seven Medicare Advantage enrollees in 2015.
In nine of those counties, no plans offered a broad hospital network — Clark, NV; Cook, IL; Davison, TN; Harris, TX, Jefferson, AL; King, WA; Los Angeles, CA; Pima, AZ; and Salt Lake, UT.
Among HMOs, average monthly premiums for broad and narrow network plans were about the same, $37 versus $36. Quality ratings were also similar, with broad plans averaging 3.8 stars and narrow ones getting 4.1 stars.