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Medicare Advantage Benefits Design and Access to Cardiovascular Care

Jessica I Billig1, Shining Yang2, Jennifer R Cardin2

  • 1Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas.

JAMA Network Open
|April 7, 2026
PubMed

Insights

Medicare Advantage plans with reduced cardiologist cost-sharing increased slightly but showed geographic disparities. These plans were higher quality, yet more strategies are needed to overcome access barriers in cardiovascular care.

Area of Science:

  • Health Services Research
  • Cardiovascular Medicine
  • Health Economics

Background:

  • Financial and geographic barriers significantly worsen cardiovascular outcomes.
  • Medicare Advantage (MA) plans can mitigate these barriers by reducing out-of-pocket costs for cardiology services.

Purpose of the Study:

  • To analyze trends in MA plans offering reduced cardiologist cost-sharing.
  • To assess if these plans are available in areas with varying cardiologist supply and infrastructure.
  • To determine the quality of MA plans providing these cost-saving benefits.

Main Methods:

  • Cross-sectional study analyzing MA benefit designs from 2022-2024.
  • Examined plan benefits, enrollment data, and county-level data on cardiologist supply and care infrastructure.
  • Assessed plan quality using Healthcare Effectiveness Data and Information Set metrics.

Main Results:

  • The number of MA plans with reduced cardiologist cost-sharing and enrollment in these plans saw a modest increase from 2022 to 2024.
  • Significant geographic variability existed in the availability of these plans relative to cardiologist supply.
  • Plans with reduced cost-sharing demonstrated higher cardiovascular care quality compared to other MA plans.

Conclusions:

  • While MA plans with reduced cost-sharing for cardiologists are increasing and tend to be high-quality, geographic disparities persist.
  • Additional strategies are essential to address financial and geographic barriers to cardiovascular care access.
Abstract

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