Medicare Advantage Networks for Surgical Specialists

Area of Science:

• Health Services Research
• Surgical Network Analysis
• Medicare Policy

Background:

• Medicare Advantage (MA) enrollment surpasses traditional Medicare.
• MA plans utilize provider networks, potentially restricting patient choice.
• Limited data exists on surgical specialist inclusion within MA networks.

Purpose of the Study:

• To examine the breadth and depth of surgical specialist participation in Medicare Advantage networks.
• To identify disparities in surgical network adequacy across specialties and geographies.

Main Methods:

• Cross-sectional retrospective analysis of 2022 Medicare Advantage provider network data.
• Linked provider data with enrollment information for six surgical specialties.
• Calculated network breadth and in-network surgeons per capita, weighted by MA enrollment.

Main Results:

• The average MA network included 57.6% of surgical specialists.
• Over 1 million enrollees resided in counties with no in-network surgeons across the studied specialties.
• Network adequacy varied significantly by specialty and geography, with rural areas showing severe deficits.

Conclusions:

• While MA networks generally include a majority of surgical specialists, significant access gaps persist.
• These gaps disproportionately affect enrollees in rural and underserved areas, exacerbating existing healthcare access challenges.