Harm to Medicare Advantage Enrollees From Directory Errors and Inadequate Networks

Two important developments reveal continuing issues with provider directories and Medicare Advantage (MA) networks.

Some Directory Information Now on Plan Finder

Last month, we noted important changes for Medicare Plan Finder (MPF), the online tool that many people use to compare Medicare coverage options. One potentially helpful addition was the inclusion of integrated provider directories for some plans. But, as we flagged at the time, provider directories are riddled with errors that may disguise inadequate networks and inferior access to care. If MPF uses inaccurate information, the problems will increase.

Inaccurate Directories Pose Risks for Enrollees

Unfortunately, our fears were realized when MPF rolled out last week. The directories integrated with MPF were filled with errors and conflicting information, which could lead to people enrolling in plans that do not include their preferred providers. Dr. Oz, the head of the Centers for Medicare & Medicaid Services (CMS), downplayed concerns and said building better directories is on the agency’s “vision board” (paywalled article).

New Watchdog Report Shows Directories Are Flawed, Hiding MA Network Failures

A new report from the Department of Health and Human Services watchdog Office of Inspector General (OIG) finds that MA directories, specifically for behavioral health providers, are wildly inaccurate and the underlying networks of these providers are inadequate to serve the needs of enrollees. “Ghost networks,” where plans hide the small number of in-network providers by including inactive providers, is a longstanding issue in MA.

The OIG found that most MA plans had large numbers of inactive providers in their directories. At least one-third of the providers were inactive for more than half of the MA plans. On average, 55% of behavioral health providers listed in plans’ networks did not provide care for plan enrollees. In some plans, that number was above 60%.

Not only are the directories wrong, but the underlying networks are also dangerously inadequate. A “limited network” is a network where only 25% of providers in the plan area are contracted with the plan. OIG found that the average MA plan contracts with only 16% of behavioral health providers.

Avoiding Enrollment Traps

Medicare Rights recommends all potential enrollees confirm online plan information by contacting the plan directly and writing down everything about the conversation, including the date, name of the representative, and any outcomes. Directly contacting preferred providers to find plans they participate in is another option.

Some Help for Those Misled by Medicare Plan Finder

Those who make a bad enrollment decision based on MPF’s inaccurate directories might be able to get some relief. CMS has created a new temporary “Special Election Period for Incorrect Medicare Plan Finder Medicare Advantage (MA) Provider Directory Information.” This SEP will offer relief for people who trust the MPF directory information to choose a plan but later discover the directory was wrong.

This temporary SEP will be available to individuals who made MA enrollments with effective dates of 1/1/26 through 12/1/26.

To qualify for the SEP, individuals must

1. Rely on MPF provider directory information,
2. Enroll in an MA plan through MPF,
3. Within 3 months of coverage starting, discover that their preferred provider was not actually in the MA plan’s provider network, and
4. Call 1-800-MEDICARE for help.

People using the SEP will be able to switch to a new MA plan or return to Original Medicare (adding a Part D plan if necessary).

More Oversight Needed

These directory errors and inadequate networks reveal a stark failure of MA to provide promised coverage. MA plans are wildly overpaid for the value they offer, and inadequate networks, coupled with potentially fraudulent enrollment practices and abusive prior authorization policies are harming older adults and people with disabilities, as well as taxpayers as a whole.

Medicare Rights will continue to urge CMS to do more to clean up abuses in the program and defend high-quality health coverage for people with Medicare.

Further Reading

Read the OIG report.

Read more about the MPF issues.

Read more about ghost networks.