Medicare Advantage enrollees struggle to comprehend their plans
Just 44% of MA beneficiaries said they fully understand their plan, while 50% say they "somewhat" understand it.
Photo: Marko Geber/Getty Images
While 71% of Medicare Advantage enrollees are generally happy with their health plan, many are confused by the features of their plan and feel they're either being overbilled or are struggling with prior authorization practices, according to a new survey from Retirement Living.
Over the past year, one in 10 beneficiaries believed they were overbilled for their Medicare Advantage plan, while almost 20% of enrollees had challenges receiving care due to delays caused by the prior authorization process, the numbers showed.
Affordable costs and out-of-pocket expenses are the top reasons (70%) people enroll in Medicare Advantage, the survey found. Others include prescription drug coverage (53%), access to more providers and hospitals (42%), and comprehensive coverage options (42%).
WHAT'S THE IMPACT
People's satisfaction with their MA plans is often positive when comparing them to their previous plans. Sixty-one percent of respondents felt their current coverage outperformed their previous plan, including traditional Medicare Parts A and B, individual insurance plans and Medicaid.
Despite the generally positive reviews, the program still lacks in a few key areas. Medicare Advantage members were less satisfied with their plan's telehealth services (27%) and online and mobile access (18%).
As for medical concerns, only 12% were satisfied with their plan's chronic disease management program, 7% with meal support and transportation, and 6% with caregiver support and home health services.
Comprehending these plans can be a challenge for some patients. Just 44% of MA beneficiaries said they fully understand their plan, while 50% said they "somewhat" understand it, and 6% didn't understand it at all. Dental coverage, out-of-pocket costs and transportation to medical appointments were among the top factors beneficiaries struggled to understand, followed by caregiver support services, home health services, and vision and hearing coverage.
Plan members were most likely to seek clarification about their dental coverage (29%) and out-of-pocket costs (24%). When coverage questions like these arose, 73% consulted their plan's website, and 44% contacted the customer service department.
While most respondents were satisfied with their MA plans, around one-quarter of members were discouraged by limited service providers or coverage for certain procedures. A few members believed they were overbilled for their plan (just 10%), and 20% had challenges receiving care due to prior authorization process delays.
Despite some minor setbacks, only about 10% of current Medicare Advantage plan members expect to change health insurance plans within the next year. Among those beneficiaries, 50% wanted to switch because of cost and 39% because of a change to their provider network.
THE LARGER TREND
While Medicare Advantage is still growing, data published in February from Chartis showed that the pace of this growth is slowing.
In 2020, 2021 and 2022, Medicare Advantage enrollment grew by 1.9 million, 2.2 million and 2.3 million beneficiaries, respectively. This year, Medicare Advantage enrollment grew by just 1.5 million. While that's still significant growth, it does show evidence of a deceleration.
At the same time, original Medicare continues to decline, losing 339,000 enrollees this year – a significant but smaller loss than previous years. Special Needs Plans (SNP) enrollment accounted for two-thirds of total market growth. SNP enrollment is up 20% from 2022, driven by considerable D-SNP enrollment gains.
A total of 29.5 million beneficiaries are now enrolled in a Medicare Advantage plan, according to Chartis.
Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com
