Q.  My wife and I are covered by a Medicare Advantage Plan, but we often find that doctors listed in our plan’s directory turn out not be in the Plan. This makes it difficult for us to rely upon the list to seek care from doctors in the network. Any comment upon this?

A.  Yes, and you are not alone. As you know, Medicare Advantage plans are a popular alternative to regular Medicare because the MA plans typically offer lower out-of-pocket costs and the same basic coverage as original Medicare, plus some additional benefits and services that original Medicare doesn’t offer. However, seniors need to make sure they know how their plans work

Medicare Advantage plans rely upon members seeking care from In-Network providers and they typically have different coverage rules for out-of-network care. It is therefore important to know which doctors and hospitals are in a plan’s network when you seek care. Reliance solely upon your plan’s provider directory could lead to surprises and unexpected medical bills.

A recent government review of Medicare Advantage plans revealed that their provider directories were often riddled with errors. The most egregious errors were the frequent identification of doctors as being in the Plan Network, who actually were not. In this regard, the Centers for Medicare & Medicaid Services (CMS) conducted a review of online provider directories for Medicare Advantage plans.  It found that there was incorrect information for half of the 5,832 doctors listed in the directories of 54 Medicare Advantage plans, together representing a third of all Medicare Advantage providers and covering approximately 17 million Americans.

As a result of that review, CMS warned 21 Medicare Advantage insurers to fix the errors by February 6, 2017, or face serious fines.

Before purchasing a Medicare Advantage plan, you should double check with the doctors and hospitals you use in order to verify that they are part of your Plan’s provider network. Once you are enrolled, and before you arrange for care from a new medical provider listed in your directory, you should first call the provider’s office and verify that he or she is actually still part of your plan’s network.  Doing so may prevent some unexpected bills for out-of-network medical care and help make your selected plan work for you.


CMS Report:  Online Provider Directory Review Report; Kaiser Health News Article