Experts raise concern about high cost-sharing for imaging in some Medicare Advantage plans

Researchers are raising concern about high cost-sharing for imaging in Medicare Advantage. 

Such privatized plans for seniors have grown in popularity, with about 34 million Americans on Medicare Part C last year, quadruple the amount in 2007. This represents about 54% of all eligible beneficiaries as of 2025, experts write in the American Journal of Roentgenology. 

Advantage plans must cover all medically necessary services, same as traditional Medicare. However, private insurers have greater leeway in deciding how much patients must spend out of pocket on radiology services. 

“Resulting variation across plans in patient cost-sharing for covered services could have implications for patient access to clinically indicated imaging,” Jessica I. Billig, MD, a hand surgeon and health policy researcher with the UT Southwestern Medical Center, Dallas, and co-authors wrote July 1. 

To better understand this landscape, Billig and colleagues analyzed publicly available data from CMS, comparing 2018 benefits features (the earliest available information) against 2026. The investigation focused solely on health maintenance (HMO) and preferred provider organization (PPO) plans. Altogether, the study sample included over 4,000 plans in 2018 and nearly 7,000 from this year. 

No plans in either year reported a deductible for radiology services, the study found. As of 2018, over 98% required patient cost-sharing for advanced diagnostic imaging (i.e., CT and MRI). This included 37% who charged only co-insurance, 21% only a co-payment and 40% that had both. As of 2026, about 99% of Medicare Advantage plans required patient cost-sharing for advanced imaging. Of them, 35% charged only coinsurance, 15% only a copayment, and 49% had both. 

Among plans requiring coinsurance, the most common rate was 20% (98% of such plans in 2018 and 96% in 2026). The maximum rate was 25% as of six years ago and 50% currently. As of 2026, about 2% of plans requiring coinsurance had a rate of 41% to 50%. Meanwhile, among plans requiring a copay, the median amount was $195 in 2018 and $260 as of 2026. The max copay charged was $600 in 2018 and $780 currently. About 2% of plans requiring a copay had an amount of $401 to $500 this year. 

Billig and colleagues believe the emergence of a small percentage of plans high patient costs for imaging “warrants further scrutiny.” 

“These high costs could pose barriers to care for such plans’ beneficiaries,” they wrote. “The findings are relevant to CMS oversight of MA benefit design and beneficiary protections,” they added.