CMS’ Medicare Provider Directories Have High Levels of Inaccuracies

CMS’ Medicare Provider Directories Have High Levels of Inaccuracies

While Medicare’s open enrollment completed last Friday, December 7, beneficiaries who enrolled into or switched Medicare Advantage plans in order to stay with their current providers may be in for a surprise come January 1, 2019. A third report this season has come out stating gross inaccuracies in the Centers for Medicare and Medicaid Services’ (CMS) provider directories as listed on Medicare.gov. This means that beneficiaries who relied on CMS’ provider directories to make their Medicare Advantage (MA) plan enrollment decisions this fall, may find that they were misinformed, and that their plan doesn’t actually cover their doctors.

This is a big deal. Millions of beneficiaries across the country rely on CMS to provide accurate AND unbiased information to make their health care choices. And CMS has failed on both accounts this year. There are numerous examples of how CMS is deliberately steering beneficiaries into Medicare Advantage plans without equal information on options and unique benefits in choosing Original Medicare (see MA Steering Continues – Advocates & Members of Congress Write Letters of Concern to CMS and a beneficiary’s letter regarding MA plan steering).

Below are some of the provider directory inaccuracy statistics in CMS’ 3rd review compiled by our partners, Center for Medicare Advocacy.

The CMS review found that:

  • Almost half of the provider directories (48.74%) had at least one inaccuracy.
  • Percentage of inaccuracies by MA organization ranged from 4.63% for the best network listing to 93.02% for the worst.
  • The majority of MA organizations had between 30% and 60% inaccuracies.
  • “Providers should not have been listed at 33.14% (3,481) of the locations…either because the provider did not work at the location or because the provider did not accept the plan at the location.”
  • “85.64% of locations with deficiencies…had deficiencies of the highest weighted, most egregious errors.”
  • 41.75% of all locations listed had inaccuracies “with the highest likelihood of preventing access to care.”

Beneficiaries who find themselves in a plan without access to their providers due to these inaccuracies can switch into a different plan during the Medicare Advantage Open Enrollment Period that runs January 1 – March 31. Please contact your local Health Insurance Counseling and Advocacy Program (HICAP) for assistance.

Karen Fletcher
Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.

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