Medicare Advantage: Ensuring Accurate Provider Directories and Protecting Patients from Errors.
This law mandates that Medicare Advantage plans maintain highly accurate and frequently updated online directories of participating healthcare providers, with verification required at least every 90 days. Crucially, starting in 2028, if a patient relies on an incorrect directory listing and sees an out-of-network doctor, their out-of-pocket costs will be limited to the lower in-network rate. This aims to protect beneficiaries from unexpected medical bills due to plan errors and increase transparency.
Key points
MA plans must verify and update provider directory information (including acceptance of new patients and telehealth options) at least every 90 days.
Patients are protected financially: if a provider is listed incorrectly as in-network, the patient pays the lower in-network cost-sharing amount.
Plans must annually calculate and publicly report an accuracy score for their provider directories, increasing transparency for consumers.
Introduced
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