mrs. burton is a retiree with substantial income. she is enrolled in an ma-pd plan and was disappointed with the service she received from her primary care physician because she was told she would have to wait five weeks to get an appointment when she was feeling ill. she called you to ask what she could do so she would not have to put up with such poor access to care. what could you tell her?

Mrs. Burton, as a retiree with substantial income enrolled in a Medicare Advantage Prescription Drug (MA-PD) plan, who is facing a long wait time of five weeks to see her primary care physician when feeling ill, has several options to improve her access to care:

• She can file a grievance or complaint with her Medicare Advantage plan about the lack of timely access to care. Plans are required by CMS to meet certain wait-time standards, such as providing care within seven business days for non-emergency but urgent needs, and within 30 days for routine care. Filing a grievance can prompt the plan to address the issue

• She may consider seeking care from other providers within her MA-PD plan network who might have shorter wait times for appointments.
• If the plan’s access issues persist, she could explore switching to another Medicare Advantage plan during the next enrollment period that offers better access to primary care.
• Additionally, if she feels her urgent health needs are not being met timely, she could seek care at urgent care centers or emergency departments as appropriate.

Overall, the first step is to formally notify her plan by filing a grievance about the poor access to care, which is a recognized method to address such problems under Medicare Advantage regulations