Medicare Advantage Networks

Some Medicare Advantage networks are large and some are small.  Some Medicare Advantage networks change often while others rarely lose doctors.

About once each month, someone calls me to say they are moving from California to Arizona and they need to find a new Medicare Advantage plan when they arrive in Arizona.  I tell them what their Medicare Advantage options are – based on their new zip code.

Then I tell them they will need to find a primary care provider (PCP) before they can fill out an application for an Arizona Advantage plan.  That’s because almost all Medicare Advantage plans in Arizona are HMOs and these plans require referrals from a PCP in order to see a specialist, or to get lab tests.

Today I was helping a client find a PCP in the Apache Junction area (outside of Phoenix).  I used the online provider search for one of the largest Medicare Advantage companies in Arizona and came up with a list of 20 primary care providers within a 10 mile radius of my client’s new address.

My next step was to call the doctors’ offices and ask if the doctor listed in the directory is taking new patients – and how far out the doctor schedules new patient appointments.  Some doctors see new patients within a week, while others (with large patient lists) might have a two-month wait for new patients.

I’m not going to name names, but I will say that the Medicare Advantage plan I was working on is run by one of the largest insurance companies in the country.  And the network for the Advantage plan is actually owned by that insurance company. And at first glance, the list of primary care providers looks pretty extensive.  But then I started to call the doctors on the list.

Medicare Advantage networks might not be as good as they appear on paper.

The first number I called was a non-working number.

The next doctor I called turned out to have “gone out of business” a year ago.

A third number got me a fax machine.

A fourth number I dialed did get me the doctor’s answering machine – but it sounded like it was his personal machine.  Very odd.

Finally, I dialed a number and got an actual doctor group – and the PCPs in the group are taking new patients.

I kept calling and got another office with several PCPS who are taking new patients.

After spending an hour making phone calls, I was able to give names and numbers to my client to set an appointment with a new PCP.  My next project will be to notify the Medicare Advantage plan that their online directory is very much out of date.

I know there have been complaints to Medicare that changes to Medicare Advantage networks can leave people with limited doctor choices.  I have read that Medicare is telling Advantage plan management that they need to keep their directories up to date.  It looks like some Advantage plans need to get moving on this assignment.

My next assignment is to look at the networks for the other Advantage plans my client might consider.  I guess I’ll be making lots more calls over the next few days.

There are supposed to be new Medicare rules that require Advantage plans to keep their online directories up to date.  I wrote about this last year:




Leave a Reply

Your email address will not be published. Required fields are marked *