A new survey from the Commonwealth Fund examines beneficiary experiences with marketing outreach from private Medicare Advantage (MA), Medigap, and Part D plans.

The surveyors asked beneficiaries about these interactions, including any impact on their Medicare coverage decisions. The survey was conducted between November 30 and December 8, 2022, which occurred during the latter part of last year’s Fall Open Enrollment period. Key findings include:

• Plan marketing is often overwhelming. Nearly all beneficiaries saw advertisements and received phone calls, mailings, and emails on a weekly basis. Some experienced even more. Every day, over 75% saw TV or online ads, while 33% received phone calls.

• Fraudulent tactics endure. Many respondents reported Medicare marketing that runs afoul of federal rules, including communications from “Medicare” promoting a specific plan (51%) and unsolicited calls from plans and brokers (74%). Few know what to do about it. About one in five survey participants said they did not know how to file a complaint about Medicare marketing and didn’t think they could figure out how.

• Harmful marketing practices disproportionately target and impact lower-income beneficiaries. Of the 14% of people who stayed on the phone after an unsolicited marketing call, nearly one in three lived on $25,000 or less per year. They were also more likely than those with higher incomes (defined as $50,000 or more) to be asked their Social Security or Medicare numbers outside the enrollment process (22% vs. 6%) and to feel pressured by an insurance broker or agent (21% vs 7%).

• Misleading marketing is widespread. Across all income groups, similar shares of beneficiaries (11% to 12%) chose plans because they believed their doctor to be “in network,” only to discover otherwise post-enrollment. However, lower income respondents were more likely to report seeing, reading, or receiving advertising information that was later found to be untrue (28% vs. 15%).

• All reported seeing, reading, or receiving advertising information that was later found to be untrue (28% vs. 15%).

• Growing plan numbers further complicate beneficiary decisions. Most respondents (96%) said that when they have too many plan options, they are more likely to stick with their current plan than switch.

• But these underlying choices may be sub-optimal. Most of the survey participants turned to friends and family (27%) and insurance brokers or agents (22%) for enrollment advice. But less than half knew there were barriers to switching from MA to Original Medicare with a Medigap, suggesting these and other strategies are inadequate.

• Beneficiaries need clear, comprehensive, and unbiased enrollment assistance. More than one in three said they would like to know more about out-of-pocket costs and benefits of their coverage options, and one in four said that they would like more one-on-one help to make their coverage decision.

The report comes amid seemingly endless plan advertisements and a recent increase in beneficiary complaints about confusing and misleading tactics, in particular regarding MA. These surges coincide with a steep increase in MA plan offerings. For 2023, the average beneficiary had access to 43 plans, over twice as many as in 2018. As the survey results show, an abundance of choice often makes comparative analysis more challenging and less likely. This can lead to sub-optimal plan selections and subsequent inertia, which can in turn have detrimental and unanticipated results, like higher costs and problems accessing preferred providers.

As the report notes, recent rule changes will help: “The Biden administration has taken steps to reduce future confusion: restricting use of the Medicare name, prohibiting ads that don’t mention a specific plan, and banning sales presentations immediately following educational events.”

Medicare Rights welcomes these updates. To more fully protect people with Medicare, we support additional reforms to the choice architecture and beneficiary access to care. This includes setting and enforcing standards for the marketing of supplemental benefits, restoring recently weakened consumer protections, boosting plan oversight, filling gaps in marketing rules; and adequate funding for unbiased beneficiary education, including State Health Insurance Assistance Programs (SHIPs). We also urge improvements to simplify enrollment, such as BENES 2.0, and greater attention to Medigap restrictions as well as inaccurate provider directories and mid-year network changes that may leave enrollees without access to the care and providers of choice.