Primary Care Cost Sharing in Medicare Advantage

What are the trends in and associated factors of $0 cost sharing for in-network primary care physician (PCP) visits among Medicare Advantage (MA) plans?In this cross-sectional study of MA plans from 2019 to 2025, the proportion of MA enrollees in plans offering $0 cost sharing for in-network PCP visits increased from 46.4% to 78.1%. This benefit was more common in less restrictive primary care networks, higher quality plans, and urbanized and high MA-penetration areas, but less in zero-premium plans and high-poverty counties.The rapid expansion of $0 cost sharing for in-network PCPs signifies improved beneficiary access, but its uneven distribution raises equity concerns and implies strategic trade-offs in plan design.

Corresponding Author: Changchuan Jiang, MD, MPH, Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 6000 Harry Hines Blvd, Dallas, TX 75390 (changchuan.jiang@utsouthwestern.edu).

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