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Primary Care Cost Sharing in Medicare Advantage.
Changchuan Jiang1,2,3, Chuan Angel Lu1, Lesi He2
1Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
JAMA Health Forum
|July 10, 2026
Summary
Medicare Advantage plans rapidly expanded $0 cost sharing for primary care physician visits, but access remains unevenly distributed, particularly in high-poverty areas.
Area of Science:
- Health Services Research
- Health Economics
- Public Health Policy
Background:
- Medicare Advantage (MA) plans utilize cost-sharing to encourage high-value care.
- National data on $0 cost sharing for in-network primary care physician (PCP) visits in MA plans are limited.
Purpose of the Study:
- To analyze trends in $0 cost sharing for in-network PCP visits within MA plans.
- To identify plan- and county-level factors associated with the offering of this benefit.
Main Methods:
- Retrospective ecological analysis of MA plan-county data from 2019 to 2025.
- Inclusion of general enrollment MA plans (HMO, PPO, HMO-POS).
- Multivariable mixed-effects logistic regression to identify associated factors.
Main Results:
- Enrollment in MA plans with $0 PCP cost sharing surged from 46.4% in 2019 to 78.1% in 2025.
- Plans with $0 cost sharing were more common among PPO plans, those with higher star ratings, and in urbanized counties with higher MA penetration and minority populations.
- Zero-premium plans and plans in high-poverty counties had lower availability of $0 PCP cost sharing.
Conclusions:
- $0 cost sharing for PCP visits has significantly expanded in Medicare Advantage but exhibits uneven distribution.
- Lower availability in zero-premium and high-poverty areas raises equity concerns regarding access to primary care.
- Further assessment is needed to determine if market-driven benefit designs ensure equitable access for high-risk populations.
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