JAMA Netw Open. 2026 Apr 1;9(4):e265439. doi: 10.1001/jamanetworkopen.2026.5439.
ABSTRACT
IMPORTANCE: Financial and geographic barriers are associated with worse cardiovascular outcomes, underscoring the need to improve access to cardiovascular care. Medicare Advantage (MA) plans offer reduced cost-sharing for cardiologists, potentially mitigating financial barriers to cardiovascular care through minimizing out-of-pocket costs.
OBJECTIVES: To determine how availability of Medicare Advantage plans with reduced cost-sharing for cardiologists has changed over time, whether plans offer reduced cost-sharing to beneficiaries in communities with more or less cardiologist supply or cardiovascular care infrastructure, and whether such benefits are offered by high-quality plans.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of MA benefit design related to cardiovascular care used plan benefits package and MA enrollment data from December 31, 2022, to December 31, 2024. Participants were MA beneficiaries. Data were analyzed from March 1 to May 23, 2025.
EXPOSURES: MA plans with reduced cost-sharing for cardiologists.
MAIN OUTCOMES AND MEASURES: The primary outcomes were (1) enrollment patterns in MA plans offering reduced-cost sharing for cardiologists (measured as quarterly enrollment in such plans from 2022 to 2024), (2) number of MA plans with reduced cost-sharing for cardiologists mapped to county-level cardiologist supply (measured as the number of cardiologists per 1000 MA beneficiaries) and cardiovascular care infrastructure (measured via individual measures and a composite index of 3 county-level measures), and (3) quality of these plans vs other MA plans (measured via 3 metrics of cardiovascular care-related quality from the Healthcare Effectiveness Data and Information Set).
RESULTS: Among 2993 plans with reduced cost-sharing for cardiologists and 3143 counties, the number of plans offering reduced cost-sharing for cardiologists (from 134 of 6448 [2.1%] in 2022 to 158 of 6808 [2.3%] in 2024) and enrollment in such plans (1.4 million in 2022 to 1.5 million in 2024) increased during the study period. Across counties, the number of MA plans with reduced cost-sharing for cardiologists varied considerably compared with cardiologist supply and cardiovascular care infrastructure. Reduced cost-sharing plans had greater care quality compared with other MA plans (116 of 158 [73.4%] with reduced cost-sharing for cardiologists being high quality vs 2508 of 6650 [37.7%]; P < .001).
CONCLUSIONS AND RELEVANCE: In this cross-sectional study of plans with reduced cost-sharing for cardiologists, the number of plans increased over time and tended to be higher quality compared with other MA plans. However, persistent geographic variability in number of plans offered, cardiologist supply, and cardiovascular care infrastructure underscore the need for additional strategies to minimize financial and geographic barriers for cardiovascular care.
PMID:41945346 | DOI:10.1001/jamanetworkopen.2026.5439
