The hidden trade-off: Why your Medicare Advantage plan could limit your choice of doctors

If you’re one of the millions of Americans over 60 navigating the maze of Medicare options, you’ve probably heard the pitch: Medicare Advantage plans promise extra benefits, lower premiums, and a streamlined experience.

But there’s a catch that doesn’t always make the headlines: your choice of doctors could be dramatically limited compared to traditional Medicare.

Let’s pull back the curtain on what this really means for your health, your wallet, and your peace of mind.

More Plans, Fewer Doctors​

Medicare Advantage (MA) enrollment has soared in recent years, with the average beneficiary able to choose from a whopping 42 plans in 2025. That sounds like a buffet of options, right? But here’s the rub: most of these plans use “provider networks”—lists of doctors, hospitals, and specialists you’re allowed to see. Step outside that network, and you could face higher bills or, in some cases, no coverage at all.

A recent analysis found that, on average, Medicare Advantage enrollees had access to just 48%—less than half—of the physicians available to those with traditional Medicare in their area. That’s a pretty steep drop in choice, especially if you have a long-standing relationship with your doctor or need specialized care.

Why Are Networks So Narrow?​

Insurers use networks to control costs and negotiate better rates. By steering patients to a select group of providers, they can offer perks like dental, vision, or gym memberships. But the trade-off is clear: you may have to switch doctors, travel farther for care, or face delays if your preferred specialist isn’t in-network.

And it’s not just about numbers. The size of a network doesn’t guarantee you’ll find the right doctor with the right expertise, or that they’re even accepting new patients. In fact, some directories are riddled with errors—listing “phantom” doctors who aren’t actually available.

A Patchwork of Access: Where You Live Matters​

The breadth of Medicare Advantage networks varies wildly depending on where you call home. In some counties, like San Diego, CA, MA enrollees had access to just 18% of the doctors available to traditional Medicare beneficiaries. In others, like Pima, AZ (Tucson), that number climbed to 58%.

If you live in a county with a large population of people of color, the networks tend to be even narrower—just 37% of local doctors, compared to 52% in less diverse areas. This means that the promise of “choice” in Medicare Advantage can look very different depending on your ZIP code.

Not All Plans Are Created Equal​

Even within the same county, the difference between plans can be dramatic. In Minneapolis, for example, some plans covered as few as 14% of local doctors, while others included up to 88%. That’s a huge swing—and it’s not always easy to spot when you’re comparing plans.

And don’t be fooled by those shiny “star ratings” you see advertised. While these ratings reflect things like customer service and preventive care, they don’t tell you anything about how many doctors are in the network. A five-star plan could still have a very narrow selection of providers.

Specialists, Primary Care, and the “Phantom” Problem​

If you need a specialist, you might fare a bit better. Medicare Advantage plans are required to include certain types of specialists, and the analysis found that up to 72% of ophthalmologists and 61% of neurologists were in-network, compared to just 55% of primary care doctors. But again, these numbers can be misleading if the directory isn’t up to date.

Hospital-based doctors—like emergency physicians and anesthesiologists—are less likely to participate in MA networks. The good news: if you need emergency care, you’re covered regardless of network status. But for other types of care, you could be on the hook for higher costs if your doctor isn’t in-network.

Also read: You could qualify for $1,000s in medical debt relief—see if yours will be cleared automatically

PPOs vs. HMOs: Does Plan Type Matter?​

Preferred Provider Organizations (PPOs) generally offer broader networks than Health Maintenance Organizations (HMOs). In 2022, PPOs included about 54% of local doctors, compared to 45% for HMOs. But don’t assume all PPOs are generous—some HMOs actually have larger networks than the average PPO. The only way to know for sure is to check the details for each plan.

The Insurer Factor: Who’s Got the Biggest Network?​

Some insurers do a better job than others at building broad networks. UnitedHealthcare and Blue Cross Blue Shield plans included about 58-59% of local doctors, while Humana and CVS plans covered less than half. But even within the same company, network size can vary from plan to plan and county to county.

Rural vs. Urban: Surprising Twists​

You might expect rural areas to have the narrowest networks, but the opposite is true—on average, rural MA enrollees had access to 53% of local doctors, compared to 47% in metropolitan areas. However, since there are fewer doctors overall in rural areas, a “broader” network doesn’t always mean better access.

Also read: CVS says quality coverage is on the rise—81% of members now in highly rated Medicare Advantage plans

Why This Matters: Real-World Impact​

Let’s say you’ve been seeing the same cardiologist for years, and you switch to a Medicare Advantage plan to save on premiums. If your doctor isn’t in-network, you’ll either have to pay more, find a new provider, or—worst case—go without the care you need. For those managing chronic conditions or complex health needs, this can be more than an inconvenience; it can be a serious health risk.

The Information Gap: Why Choosing a Plan Is So Hard​

You’d think with all the technology at your fingertips, comparing networks would be a breeze. Not so. Until recently, the official Medicare Plan Finder didn’t include provider network information for MA plans. Beneficiaries had to visit each insurer’s website, hunt down directories, and hope the information was accurate and up to date. Even now, the data is often incomplete or hard to compare.

The Centers for Medicare & Medicaid Services (CMS) is working to improve this, with plans to post aggregated provider directories online and require insurers to submit up-to-date information. But for now, it’s still a challenge.

How to Protect Yourself Before You Enroll​

• Make a List: Before enrolling, write down your must-have doctors and specialists.
• Check Directories: Visit plan websites and call your providers to confirm they’re in-network.
• Ask About New Patients: Even if a doctor is listed, they may not be accepting new patients.
• Consider Plan Type: PPOs may offer more flexibility, but always check the specifics.
• Don’t Rely on Star Ratings Alone: They don’t reflect network size or access.
• Review Annually: Networks can change from year to year, so review your plan during open enrollment.

Read next:

• The hidden Medicare gaps that could drain your retirement savings
• Medicare’s new plan tool has errors—what seniors need to know before choosing coverage
• The Medicare Advantage "ghost network" trap: Why your mental health provider directory might be haunted

Key Takeaways

• On average, Medicare Advantage enrollees have access to only about half (48%) of the doctors available to those with traditional Medicare, with significant variation depending on the plan, region, and physician specialty.
• Medicare Advantage plans in areas with more people of color, or greater competition from many insurers, tended to have even narrower networks, with enrollees in those counties having access to a smaller proportion of local doctors than people in other areas.
• There was wide variation in network size even within the same county and among different plans from the same insurer, making it difficult for many Medicare beneficiaries to clearly compare which doctors they could see under different plans.
• Star ratings for Medicare Advantage plans did not reflect the breadth of their doctor networks, and most comparison tools didn’t show detailed provider network information, leaving potential enrollees struggling to judge which plan would give them the best access to their preferred doctors.

Have you had to switch doctors because of a Medicare Advantage plan? Did you find it easy or difficult to compare networks? What advice would you give to others in The GrayVine community?