Medicare enrollees are moving in greater numbers than ever to the program’s managed care option as a way to save money. But the tradeoff is much less ability to use their preferred doctors and hospitals.
Seniors can choose between traditional fee-for-service Medicare – which is accepted by most healthcare providers – or a Medicare Advantage plan. The latter encompasses health maintenance organizations (HMOs) or preferred provider organizations (PPOs), which control costs by creating healthcare provider networks that enrollees must use.
In theory, prospective Advantage enrollees can review lists of in-network providers before opting into a plan. But a new study by the Kaiser Family Foundation (KFF) finds that provider data often is very difficult to review, can be out of date and frequently contain inaccurate information. KFF’s review also found shortcomings in the quality of providers in some Medicare Advantage provider networks.