Geographic Access Offered by Private Plans under Medicare Part C

Medicare Part C provides beneficiaries a choice of private health insurance options. Key among the considerations in choosing a plan is the level of access to provider groups such as primary care physicians, specialists, and health care facilities. Little is known, however, about the level of access that these private plans offer. This paper presents findings from a study funded by CMS to identify potential performance measures on geographic access to guide beneficiary choice as well as to serve as a tool for audits of plan quality.

Using provider data collected from 518 of the 520 Part C contracts that offered coordinated care plans in 2009, we formulate geographic access measures covering three provider groups: PCPs, a composite of six key specialties, and general acute hospitals. Representing the first nationwide assessment of geographic access offered by Medicare Part C contracts, our results show that a large majority provide high levels of access. For example, 9 out of 10 contracts provide access to at least 2 PCPs within acceptable distances for at least 96% of beneficiaries. The average contract provides access to a hospital within an acceptable distance to 94% of beneficiaries. Although contracts generally provide high levels of access, variation does exist by region and by plan type. Further work is exploring the causes of this variation and factors associated with low access.