What’s the news: In the coming years, Medicare Advantage plans will have to maintain accurate, regularly updated provider directories and publicly report on their directory accuracy after Congress passed the bipartisan Requiring Enhanced and Accurate Lists of (REAL) Health Providers Act as part of the federal budget deal enacted this year.
Extensive AMA input helped shape the bill and the AMA applauds its passage that helps eliminate so-called ghost directories that leave Medicare Advantage patients without reliable information on which physicians are in-network. The measure creates accountability, patient protection, improved access to care, increased transparency and reduced administrative burdens on physicians.
Starting in 2028, Medicare Advantage plans will have to:
- Verify provider data at least every 90 days, or in the case of a hospital or other facility deemed appropriate by the Health and Human Services Secretary no later than once every 12 months.
- Flag unverified listings as potentially outdated.
- Remove providers no longer in-network within five business days.
The law also lays out ways for the directories to be standardized, requiring that they must include verified fields such as:
- Specialty, location and contact information.
- Whether the provider is accepting new patients.
- Disability access, language and telehealth capabilities.
In addition, Medicare Advantage plans:
- Must conduct annual statistical accuracy audits.
- Submit accuracy scores to the Centers for Medicare & Medicaid Services (CMS).
- Display their provider directories’ accuracy scores beginning in 2029; CMS will publish plan-level scores publicly.
This is one of eight major wins for patients and physicians included in the latest federal budget deal, the Consolidated Appropriations Act, 2026. These victories didn’t happen by chance. They happened because the AMA fought for them, and they were only possible because the AMA brought the full strength of its advocacy to Capitol Hill. That powerful effort encompasses thousands of interactions with congressional offices, hundreds of letters and resources, congressional testimony and more, says the “AMA Advocacy Impact Report.”
Why this win matters: Studies have shown that Medicare Advantage provider directories can be wildly inaccurate when it comes to properly listing information patients rely on to find physicians. Among the inaccurate information are physician locations, network status and specialties. The poor information also results in extra calls to physicians’ offices.
A JAMA Dermatology study found that just 26.6% of individual directory listings for dermatologists in a subset of Medicare Advantage plans were unique, accepting the patient’s insurance and offering a medical dermatology appointment.
Dozens of other studies showed similar results in the following decade.
For example, a 2023 report from the office of Sen. Ron Wyden (D-Ore.), found that when phone calls were made to 120 provider listings across 12 different health plans, 33% of the listings were inaccurate, had no working numbers or had unreturned calls. The study also found that appointments were available just 18% of the time. More than 80% of the listed, in-network mental health providers that Wyden’s staff tried to contact were “ghosts” because they were either unreachable, not accepting new patients or not in-network.
That all has a real-world impact for Medicare Advantage patients trying to make appointments with physicians.
“The results can be complicated, expensive and potentially devastating, especially to patients,” Jack Resneck, Jr., MD, a former AMA president and an author of the JAMA Dermatology study, testified before the Senate Finance Committee in 2023.
Incorrect information in provider directories shifts responsibility onto patients to locate a plan’s network provider or pay for out-of-network care, said a 2024 letter to several members of the U.S. House of Representatives.
“Additionally, the resulting delays in care can negatively impact patients’ health outcomes. Moreover, in the long run, continuing to allow inaccuracies makes it easier for plans to fail to build networks that are adequate and responsible to patients’ needs,” said the AMA letter.
Learn more: These changes build upon improvements that the Department of Health and Human Services (HHS) made last year to the Medicare Plan Finder to help patients choose plans that include their trusted physicians and hospitals.
Explore further how patients will no longer have to click through multiple websites to confirm whether their physician is in-network and learn more about what the AMA has urged HHS to require of Medicare Advantage plans.
Find out more with the AMA about provider networks and access to care.
