Complaints about gaps in Medicare Advantage networks are common. Federal enforcement is rare.

[BumRushDaShow]

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Source: CBS News

Updated on: November 20, 2025 / 10:22 AM EST


Along with the occasional aches and pains, growing older can bring surprise setbacks and serious diseases. Longtime relationships with doctors people trust often make even bad news more tolerable. Losing that support — especially during a health crisis — can be terrifying. That's why little-known federal requirements are supposed to protect people with privately run Medicare Advantage coverage when contract disputes lead their health care providers and insurers to part ways.

But government documents obtained by KFF Health News show the agency overseeing Medicare Advantage does little to enforce long-standing rules intended to ensure about 35 million plan members can see doctors in the first place.

In response to a Freedom of Information Act request covering the past decade, the Centers for Medicare & Medicaid Services produced letters it sent to only five insurers from 2016 to 2022 after seven of their plans failed to meet provider network adequacy requirements — lapses that could, in some cases, harm patient care.

Agency officials said some plans lacked enough primary care clinicians, specialists, or hospitals, according to the letters. And they warned that failure to meet the requirements could result in a freeze on marketing and enrollment, fines, or closure of the plan. CMS declined to detail why it found so few plans with network violations over the 10 years.

Read more: https://www.cbsnews.com/news/medicare-advantage-networks-complaints-federal-enforcement/

[Karma13612]

1. Aetna Medicare Advantage plan

in my little rural corner of the world has no “in network” Dentist. So, I always have to pay 50% of my Dental cleanings and other preventative stuff.

I know that is just a drop in the bucket of all the obscenities surrounding the ACA and healthcare insurance in this country.

This is more substantial:

1) In our area, There is an 18 month waiting list to get into a Primary Care Practice. So, go to the ER or Urgent Care.
2) Starting next January, if I want the same coverage level, with the same copays and breadth of services, my plan premium will go up by $ 50 plus I still have my Medicare premium taken out of my Social Security retirement benefit which is going from $185 per month to $202.90
3) if I want to not pay the $50, my coverage drops down so there is no restorative dental care, and my copays on all sorts of things go up. A lot.
4) If I choose the $50 increase, the net amount I will get from Social Security will drop below what I have been getting each month this year. That’s because the increase in the Medicare premium and the add on of the Advantage plan is much larger than the COLA increase.

Pathetic. Absolutely pathetic.

[moreland01]

2. Do you ever wish

that you'd gone with original Medicare with a medigap plan?

[GP6971]

3. Locking per Host Consensus. Feature Piece

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