Medicare Advantage Networks

Starting in 2016  Medicare Advantage plans will be required to keep up-to-date online directories, or face large fines. The online directories allow the public (and insurance agents) to see which doctors are in a plan’s network and which ones are taking new patients.

According to an article in Kaiser Health News:

Under a rule published last month by the Centers for Medicare & Medicaid Services, Medicare Advantage plans must contact doctors and other providers every three months and update their online directories in “real time.”

Inaccuracies in the Medicare Advantage directories may trigger penalties of up to $25,000 a day per beneficiary or bans on new enrollment and marketing.

The new Medicare Advantage rules are a response to complaints from beneficiaries and doctors about “directories including providers who are no longer contracting with the [plan], have retired from practice, have moved locations, or are deceased,” CMS officials said in the notice to insurers. Some directories also list providers who are still in the plan’s network but not available to new patients.


This is certainly an issue with Medicare Advantage plans in Tucson.  I have seen doctors listed in plans’ online directories when I know they have retired or moved on.  I have also seen many primary care doctors listed as “accepting new patients” – but when I call the office I have been told they are not taking new patients.

So this new rule sounds like a good idea…. but requiring plans to contact every provider in their network every three months…..  that sounds like an expensive requirement.

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