Medicare Advantage
MedPAC Analysis Finds Medicare Advantage Provider Directories May Overstate Physician Network Participation
A new presentation to Congress's Medicare advisory body compared plan directories to actual encounter records and found meaningful gaps, raising concerns just as open enrollment opens October 15.
By the Goodsurance editorial teamOctober 10, 2026
As Medicare's Annual Enrollment Period approaches, a new analysis presented to MedPAC, the independent body that advises Congress on Medicare, found that provider directories used by Medicare Advantage plans may overstate how broadly physicians actually participate in those networks.
At its October 8-9, 2026 public meeting, MedPAC staff compared two data sources: plan-submitted provider directories, which list doctors as in-network, and Medicare Advantage encounter records, which document the care that enrolled beneficiaries actually received. The two sources did not consistently align. Some clinicians listed in directories did not appear in encounter data, which can reflect limited involvement with the plan, not accepting new patients through it, or no longer actively participating despite remaining listed.
MedPAC: Medicare Advantage directories may list doctors who rarely see plan patients. Open enrollment starts October 15, verify before you enroll.
Beneficiaries rely heavily on provider directories when deciding which Medicare Advantage plan to choose, typically checking whether their primary care physician, specialist, or hospital is covered before enrolling. Inaccuracies in those listings can result in beneficiaries selecting plans whose networks do not include all of the providers they expected.
MedPAC commissioners expressed particular interest in understanding how this gap affects enrollee access to cancer care.
The analysis is part of MedPAC's broader 2026-2027 study agenda examining Medicare Advantage network accuracy. MedPAC does not set policy directly, but its findings regularly inform CMS rulemaking and legislation.
The timing is significant. Open enrollment runs October 15 through December 7, exactly the period when millions of people consult directories to compare plans. Anyone who finds a plan whose directory lists their doctor should consider calling the doctor's office to confirm the physician is actively accepting new patients through that specific plan before enrolling.
In plain words
Every fall, people with Medicare use online directories to pick a plan. These directories list which doctors are in each plan's network. A federal advisory group called MedPAC looked at those directory listings and compared them to real medical records from the same plans. The two did not always match. Some doctors listed in a plan's directory may not be regularly seeing patients through that plan. MedPAC shared these findings at its October 8-9, 2026 meeting. The group advises Congress but does not write the rules itself. Open enrollment for 2027 plans starts October 15 and ends December 7. That is when this kind of mismatch matters most, because people are choosing plans based partly on which doctors are listed. Before you enroll, calling your doctor's office to confirm they take the plan is a good extra step.
Understand the basics first
Source: MedPAC
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