Medicare Advantage Networks for Surgical Specialists

Abstract

Background: Medicare Advantage (MA) covers more Medicare beneficiaries than traditional Medicare. MA plans limit the providers beneficiaries can see through their provider networks. Yet, there is limited evidence examining the inclusion of surgical specialists in MA plan networks.

Study design: We conducted a cross-sectional retrospective analysis of MA surgical networks across 6 specialties: general surgery, orthopaedic surgery, thoracic surgery, plastic surgery, vascular surgery, and neurosurgery. We linked 2022 Ideon provider network data with 2021 IQVIA OneKey provider data and 2022 MA plan enrollment information. We calculated network breadth (the share of specialists included in a network) and the total number of in-network surgeons per 100,000 county population. Measures were stratified by specialty and geography and weighted by MA enrollment to reflect the average enrollee's plan.

Results: Among 36,584 network counties representing 20.9 million MA enrollees, the mean enrollee's network included 57.6% surgical specialists. The average network had more in-network surgeons than required under network adequacy criteria. Plastic surgery networks were the narrowest, with an average breadth of 47.1%, whereas vascular, thoracic, and orthopaedic surgery networks exceeded 60%. More than 1 million MA enrollees lived in counties with zero in-network surgeons across all 6 specialties. Gaps were especially severe in rural and noncore counties, where enrollees often had access to fewer than 1 in-network surgical specialist.

Conclusions: MA networks include more than half of surgeons but may further limit access in areas where surgeons are already in limited supply.