How do Medicare Advantage plans with reduced cardiologist cost-sharing vary over time, geography, and plan quality?

Medicare Advantage (MA) plans offering reduced cost-sharing for cardiologists are becoming more common, but access remains uneven across counties—this benefit is more concentrated among higher-quality plans but not consistently aligned with areas of greatest cardiovascular care need.

In a cross-sectional analysis of 2022–2024 Medicare Advantage data, the PROPEL team examined plan benefits, enrollment, county-level cardiologist supply, cardiovascular care infrastructure, and HEDIS quality metrics. Across the study period, 2,993 plans with reduced cardiologist cost-sharing were offered across 3,143 U.S. counties. The number of plans offering reduced cost-sharing for cardiologists increased modestly, rising from 134 in 2022 to 158 in 2024, with enrollment growing from 1.4 million to 1.5 million Medicare beneficiaries.

Despite this growth, access to plans with these cost-sharing reduction benefits remained uneven. More than a third of counties (35.6%) had no plans offering reduced cost-sharing for cardiologists, and a majority (62.1%) had no cardiologists. Gaps in cardiovascular care infrastructure were also striking, with half of U.S. counties having no such resources. Plans with reduced cost-sharing were disproportionately high quality, with nearly three-quarters (73.4%) rated as high quality, compared with 37.7% of other Medicare Advantage plans.

While increasing over time, the availability of benefits like reduced cardiologist cost-sharing is uneven among Medicare Advantage plans. Future work should identify whether these benefits meaningfully improve access and outcomes—and how to better align plan offerings with population need. 

Article link: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2847400