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Study Finds Ongoing Confusion Among Medicare Beneficiaries

Analysis  |  By Melanie Blackman  
   April 14, 2021

GoHealth CMO, Paul Hain, MD, shares misconceptions Medicare beneficiaries have about Original Medicare and Medicare Advantage.

A recent GoHealth study found a knowledge gap among Medicare beneficiaries related to the differences in plan coverage of Original Medicare (OM) and Medicare Advantage (MA).

The Chicago-based health insurance marketplace's study revealed that OM beneficiaries were less knowledgeable than the MA beneficiaries in multiple areas, including benefits and costs.

The findings revealed the following about those enrolled in MA:

  • Nearly 80% said cost savings is why they enrolled
  • A majority are enrolled due to additional benefits

The study also revealed that for those enrolled in OM:

  • About 30% indicated that they are not familiar with MA benefits
  • More than four-in-five respondents believe their coverage alone provided out-of-pocket maximum, which it does not
  • Three-in-10 believe Medicare Advantage is more expensive
  • Nearly two-thirds were not familiar with Medicare Advantage providing Part A and Part B coverage
  • More than one-third responded that they did not know Medicare Advantage has more benefits

Paul Hain, MD, CMO at GoHealth, recently told HealthLeaders that what worried him the most are the misperceptions of what Medicare does.

"If 86% of folks on [Original Medicare] think that they're covered for a maximum that they might have to pay each year in terms of coinsurance and deductible, and they're not, that can be a catastrophic misperception," Hain said.

Due to 30% to 40% of seniors living below 200% of the federal poverty limit, having to come up with money for a surprise bill is a big problem, Hain added.

He also found it concerning that OM beneficiaries thought their plan covered everything they need, especially as consumers have dealt with surprise medical bills in recent years.

Additionally, the study results surprised Hain as he said he wasn't aware that there was so much misperception about OM and MA coverage.

He did note that the lack of confusion among Medicare beneficiaries is to be expected as it is a more familiar system for consumers, especially among those who only look at the options later in life.

"I think a lot of folks are defaulting to [Original Medicare] without understanding that they should have a supplemental policy," Hain said. "Or [they don't know] there's a different deal over in [Medicare Advantage] that might suit them much better."

Hain added that the take home is “most seniors probably shouldn't be doing this alone” and that healthcare organizations can step in to help Medicare beneficiaries choose the correct plan that fits their needs and avoids surprise bills and payments.

Related: Related: Is GoHealth, a recent IPO stock, the Teladoc of Medicare?

Related: Opinion: Sen. Sanders proposal brings Medicare closer to the brink of collapse

Melanie Blackman is a contributing editor for strategy, marketing, and human resources at HealthLeaders, an HCPro brand.

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