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Key Factors Driving Enrollees to Medicare Advantage Plans

Analysis  |  By Jay Asser  
   October 21, 2022

More benefits and a limit on out-of-pocket costs are the top reasons older adults are opting for Medicare Advantage (MA).

With the open enrollment period under way, millions of Americans are weighing their coverage options to make the best decision for their health needs.

The choice between traditional Medicare and MA plans can come down to preference, guidance, and information.

According to a survey by the Commonwealth Fund, more benefits and out-of-pocket cost limits are the primary drivers for enrollees selecting MA plans, while greater choice in providers leads the way for those choosing traditional Medicare.

The 2022 Biennial Health Insurance Survey uses responses from 1,605 older adults aged 65 and above who were enrolled in Medicare to determine why they chose MA or traditional Medicare, and what resources they utilized.

About one in four (24%) respondents cited additional benefits as their reason for choosing MA, followed by out-of-pocket cost limits (20%), recommended by trusted people (15%), offered by my/partner's former employer (11%), maintain same insurer (9%), help managing healthcare (8%), and doctor recommended (3%). 'Other' was chosen by 8%.

For traditional Medicare, more provider choice led the way for 40% of respondents, followed by recommended by trusted people (9%), continuing coverage from employer (7%), VA healthcare/Tricare for Life (6%), lower cost (4%), and have supplemental insurance (4%). Nearly a quarter of those surveyed chose 'other.'

While most of the respondents (40%) said they did not receive help to guide their plan choice, the ones that did receive help relied primarily on an insurance broker for Medicare (30%) and MA (31%). About one in five (18%) were guided by friends and family, with a small percentage using the Medicare.gov website and hotline or the state health insurance assistance program.

"Medicare beneficiaries, regardless of their source of coverage, seem to most frequently rely on the one-on-one help provided by brokers and agents in choosing a Medicare plan," authors of the survey said. "But brokers and agents are paid commissions by insurers, which can influence the kind of information they provide."

How MA is advertised and marketed has been a source of frustration for some, who argue beneficiaries are being misled and tricked. According to the survey, 6% of enrollees used marketing as a source of information in choosing a plan. The rate varied among respondents who were Black (12%) and white (5%), as well as between those in the lowest income category (12%) and those in the highest (2%).

The findings show that where and how beneficiaries get their information on coverage options matters not only for enrollees at large, but within different subsets as well.

"It’s important to learn how these sources inform beneficiaries, whether they are equitably accessible, and what kinds of services and information are needed to fill any gaps," the authors conclude. "Regardless of where beneficiaries get information for making their coverage decisions, having accurate, easy-to-use tools would help them evaluate their options."

Jay Asser is an associate editor for HealthLeaders.


KEY TAKEAWAYS

The Commonwealth Fund's 2022 Biennial Health Insurance Survey examines older adults enrolled in Medicare to determine why they chose MA or traditional Medicare, and where they received information from.

About one in four (24%) respondents cited additional benefits as their reason for choosing MA, while more provider choice led the way (40%) for respondents choosing traditional Medicare.

Respondents that received help to choose their plans relied primarily on an insurance broker for Medicare (30%) and MA (31%).


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