JAMA Health Forum | 2021
Physician Network Breadth and Plan Quality Ratings in Medicare Advantage
Abstract
Nearly 40% of beneficiaries elect to access their Medicare benefits through Medicare Advantage (MA), in which capitated private health insurers construct physician and hospital networks and a benefits package with a minimum of Medicare Parts A and B benefits. Most plans also integrate prescription drug coverage (Part D). In exchange for network and utilization controls, beneficiaries typically receive supplemental benefits and an annual cap on out-of-pocket expenses. Medicare Advantage insurers receive a quality bonus that is tied to a star rating of 4 or greater on a 5star scale. If MA insurers use networks to manage costs, enrollees may face tradeoffs between cost and quality. Narrow networks may direct enrollees to cost-effective, high-quality hospitals and physicians or limit access to necessary high-cost, high-quality care. While we know network breadth varies across MA plans1-3 and may be associated with plan quality,4 in this study, we explored the extent of narrow networks across MA, types of counties where they are common, enrollment in narrow network plans, and how networks are associated with star ratings.