Last week, we covered new KFF research on Medicare Advantage (MA) television advertisements that aired during the Fall of 2022, as people were making coverage choices for the current calendar year. In a complementary report, What Do People with Medicare Think About the Role of Marketing, Shopping for Medicare Options, and Their Coverage?, KFF reveals findings from a series of Medicare beneficiary focus groups conducted during the same time frame, which capture enrollee experiences with coverage choices and plan marketing.
Many of the key takeaways reinforce KFF’s marketing analysis and Medicare Rights’ experience around misleading and aggressive plan practices.
- Focus group participants said they were inundated by Medicare marketing, including unsolicited phone calls and TV ads, and believed the ads were often misleading and deceptive.
- Many participants reported receiving unwelcome and unsolicited phone calls from brokers and plan representatives, though it was not always obvious to the participants who was calling. Similarly, nearly all had seen MA TV ads and often found those sponsorships—whether it was the government or a private company behind the ad—to be unclear.
- In general, many thought the private plan TV ads were misleading. They did not find celebrity endorsements particularly compelling and were skeptical of many of the ads, particularly those promising an array of “free” benefits.
The participants echoed what we often hear from beneficiaries about the challenges of enrolling in Medicare initially and the complexity of re-evaluating one’s coverage every year.
- Participants found selecting Medicare coverage overwhelming. Many were also confused about how Medicare works, including the different parts of the program and what is included in an MA plan vs. supplemental coverage.
- As a result, participants often looked to brokers for help. Beneficiaries were not bothered by broker commissions “as long as they felt they were getting good recommendations on their plan options.” However, there is no guarantee they were.
- While few used official Medicare resources, such as the Medicare Handbook or 1-800 Medicare, those who did found them helpful. Most had not heard of or used State Health Insurance Assistance Programs (SHIPs), which are uniquely well positioned to provide unbiased, independent Medicare counseling and assistance.
- They highlighted a number of factors that were important when first choosing their Medicare coverage, including premiums and out-of-pocket costs, access to specific doctors, availability of extra benefits, and coverage of prescription drugs.
- Most participants with MA did not review their coverage options every year, and even fewer switched plans. Most said selecting a new plan would be too much work, and they felt they would not be better off with a different option anyway. However, many wished they had had more information before initially enrolling.
Most focus group participants said they were relieved to have Medicare and satisfied with their coverage. But some, primarily MA enrollees and individuals dually eligible for Medicare and Medicaid, reported problems specific to their coverage type.
- Participants dually eligible for both Medicare and Medicaid had varying experiences signing up for Medicaid, with some choosing their coverage and others being assigned a plan. Some participants were worried about losing their Medicaid coverage in general, and during the redetermination process in particular.
- Some MA enrollees with serious medical conditions encountered high medical bills when using certain services—such as needed care that was not covered and higher than anticipated co-pays.
- MA participants, including some dually eligible individuals, also reported problematic care delays due to their plan’s use of utilization management tools like prior authorization.
- MA enrollees were generally aware of the importance of having their doctors in-network, but many nevertheless encountered situations when the doctor they wanted to see was out of network. Some dually eligible MA enrollees reported difficulty finding providers who were in-network and accepted both their MA and Medicaid coverage.
- Other MA enrollees reported challenges with using their supplemental benefits, particularly dental coverage, due to network restrictions. Common problems included cost sharing that was higher than expected, and difficulty finding a covered provider.
At Medicare Rights, we frequently hear from beneficiaries who need help understanding their Medicare coverage options and making enrollment decisions. Regardless of the coverage pathway they choose, they may then need help paying for and accessing services. But these challenges are often more pronounced for MA enrollees, due to MA-specific features that act as obstacles to choosing and using their coverage.
As MA enrollment, plan numbers, and costs grow, it is ever-more important to ensure the program is working well for enrollees. KFF’s beneficiary focus groups show there is ample room for reform. MA advertising is misleading and rampant. Plan selection is overly onerous, and official Medicare resources under-utilized. There are too many barriers to care and informed decision-making, and too few options for relief. People with Medicare need stronger consumer protections, more reliable coverage, and tougher plan oversight—without delay.