A recent article published by KFF Health News titled “Private Medicare, Medicaid Plans Exaggerate In-Network Mental Health Options, Watchdogs Say” by Tony Leys (Oct. 20, 2025) highlights a report by the Dept. of Health & Human Services Office of Inspector General (OIG) titled “Many Medicare Advantage and Medicaid Managed Care Plans Have Limited Behavioral Health Provider Networks and Inactive Providers” (October 2025). As described in the article, the report found that:
Companies running private Medicare and Medicaid insurance plans inaccurately list many mental health professionals as being available to treat the plans’ members […] some insurers effectively set up “ghost networks” of psychologists, psychiatrists, and other mental health professionals who purportedly have agreed to treat patients covered by the publicly financed Medicare and Medicaid plans. In fact, many of those professionals do not have contracts with the plans, do not work at the locations listed, or are retired, the investigators said.
Among other things, the report “found that 55% of mental health professionals listed as in-network by Medicare Advantage plans were not providing such care to any of the plans’ members.”
Also related to MA provider networks, KFF recently released a report titled “Medicare Advantage Enrollees Have Access to About Half of the Physicians Available to Traditional Medicare Beneficiaries” by Matthew Rae, Jeannie Fuglesten Biniek, Tricia Neuman, and Karen Pollitz (Oct. 27, 2025). The report’s key findings quoted below:
- “Medicare Advantage enrollees were in a plan that included just under half (48%) of all physicians available to traditional Medicare beneficiaries in their area in 2022, on average. Narrower networks limit which doctors, specialists, and other health care providers are available to Medicare Advantage enrollees, unless they are willing and able to pay more to go out-of-network. Narrower networks can also be disruptive for patients who need to switch doctors or hospitals to stay within the network for their care.
- For the one-fifth of Medicare Advantage enrollees in plans with the narrowest network, two out of three physicians available to beneficiaries in traditional Medicare in their area were out-of-network.
- Conversely, for the one-fifth of Medicare Advantage enrollees in plans with the broadest networks, fewer than one-third of physicians available to traditional Medicare beneficiaries were out of their plan’s network.
- The breadth of Medicare Advantage networks varied widely across counties. Among the 30 counties with the largest Medicare Advantage enrollment, the share of physicians available to Medicare Advantage enrollees as a share of physicians available to traditional Medicare beneficiaries ranged from an average of 18% in San Diego, CA to an average of 58% in Pima, AZ (Tucson). This variation across geographic areas means that some Medicare Advantage enrollees have more choice among health care providers than others.
- In counties where larger shares of the population were people of color, a smaller share of physicians available to traditional Medicare beneficiaries were in-network, on average, than in other counties (37% vs 52%).
- Even within the same county, physician networks often varied widely across plans. One third (32%) of all Medicare beneficiaries lived in a county where at least one plan had less than one-quarter of physicians available to traditional Medicare beneficiaries and at least one plan included at least two-thirds of physicians available to traditional Medicare beneficiaries, though these variations are difficult for beneficiaries to decipher and not obvious when potential enrollees are comparing their Medicare coverage options.
- The share of physicians available to Medicare Advantage enrollees varied by specialty. Generally, larger shares of outpatient medical and surgical specialists were in plan networks than primary care physicians, with as many as 72% of ophthalmologists available to traditional Medicare beneficiaries in plan networks compared to only 55% of primary care physicians, on average.
- Medicare Advantage plan quality star ratings were not correlated with the breadth of the physician network. Though star ratings were intended to help beneficiaries choose a plan that best meets their needs, they do not convey the information needed for potential enrollees who prioritize the breadth of the provider network.”
October 20, 2025 – D. Lipschutz