Medicare Advantage: Mandatory Accurate Provider Directories and Cost Protection.
This law mandates that Medicare Advantage plans maintain accurate and frequently updated provider directories, verified at least every 90 days. Crucially, it introduces financial protection for enrollees: if a patient schedules an appointment relying on an incorrect directory listing, they are only responsible for the lower in-network cost-sharing amount. These changes aim to simplify finding appropriate specialists and prevent unexpected medical bills.
Key points
Medicare Advantage plans must publish accurate online provider directories, updated and verified at least every 90 days.
Enrollees are protected from higher costs if they see an out-of-network provider due to an error in the plan's directory (they pay the in-network rate).
Directories must include detailed information such as availability, disability accommodations, and cultural/linguistic capabilities.
Plans must annually analyze and report on the accuracy of their directories, especially for mental health providers, with scores made public.
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