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How People Choose Medicare Options

By June 2, 2014Commentary

Researchers at the Kaiser Family Foundation conducted nine focus groups of six to eight Medicare beneficiaries in four cities, Baltimore, Seattle, Memphis and Tampa, to understand factors used in making decisions around insurance coverage beyond basic Medicare.   (KFF Report)   The factors used are pretty obvious–premiums, out-of-pocket costs, access to certain providers, familiarity with the insurer, favorable experience with plan personnel, having the same coverage as a spouse and, for Part D plans, having coverage for a specific drug.  Star ratings played no real role in choices.  Decision-making was complicated by a flood of information and difficulty in organizing and understanding it all.  Most seniors do not use the Medicare Compare tool available on the CMS website and those who did found it confusing, frustrating, and lacking useful comparisons on important factors.  Many rely on insurance agents, trusted advisors, family, friends, doctors or pharmacists.

The process of initial selection was viewed so negatively that it serves as a significant barrier to switching plans.  Fear about the effects of change lead most to not review coverage or options at annual open enrollments.  Most will ignore premium increases and other changes in their current plan to avoid changing.  For those who had switched plans at some point, desire to stay with a certain provider was a factor.  Overall it is clear that the current process for selecting a plan does not work well for most beneficiaries, not because they don’t want to make sound decisions, but because the information presented and the way it is presented is not helpful.  Medicare Compare clearly needs an overhaul, and the Medicare Star program is not meeting one of its objectives–to help beneficiaries select higher quality plans.  Research has indicated that many seniors are not in an “objectively determined” best plan for their situation.  While this is a small sample size, it strongly suggests that the shopping experience could be improved.

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