Consumer / Employer, Payers

Survey: Only 44% of MA Beneficiaries Fully Understand Their Plan

Only 44% of Medicare Advantage enrollees said they “fully understand” their plan, while 50% said they “somewhat understand” it and 6% said they don’t understand it, according to a recent survey.

Many Medicare Advantage beneficiaries don’t have a good grasp of what their health plan offers, a new survey shows.

Only 44% of Medicare Advantage enrollees said they “fully understand” their plan, while 50% said they “somewhat understand” it and 6% said they don’t understand it. The areas they struggle to understand include dental coverage, out-of-pocket costs, transportation to medical appointments and caregiver support services.

The survey was published by Retirement Living, which offers retirement resources for seniors. It included responses from 351 Americans enrolled in a Medicare Advantage plan (57% were women and 43% were men). 

About one in eight Medicare Advantage beneficiaries “misinterpreted aspects of their plan” after enrolling in coverage. When asked what confused them about their plan, 68% said complex plan details, 56% said a lack of familiarity, 44% said inadequate communication, 34% said information overload and 32% said unclear plan changes or updates. 

This confusion led to unexpected bills, higher than expected out-of-pocket costs, frustration or dissatisfaction with their plan, delayed or avoided medical care and loss of access to preferred providers. More than a quarter of Medicare Advantage enrollees said they paid out-of-pocket expenses for services they thought were covered.

“Navigating insurance coverage can be incredibly difficult, and some beneficiaries feel like they don’t know everything their plan has to offer,” the survey said.

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To better understand their Medicare Advantage coverage, 73% of respondents said they went to their plan provider’s website and 44% said they used customer service.

In addition, respondents listed several disadvantages to Medicare Advantage plans. These disadvantages include limited service providers and limited coverage for some services. Nearly 20% of respondents said they experienced difficulties in receiving care because of prior authorization. About one in 10 beneficiaries said they plan to change coverage plans in the next year, the survey also found.

Still, 71% of beneficiaries said they were satisfied with their Medicare Advantage plan. Many enrollees were satisfied with their plan’s costs, prescription drugs coverage and access to providers. 

More than 60% of beneficiaries said their Medicare Advantage plan outperformed their previous health plan. When broken down by previous coverage type, 74% of those previously enrolled in traditional Medicare said Medicare Advantage outperformed their former plan. The same percentage said this about individual health insurance. About 56% of those previously enrolled in Medicaid said that Medicare Advantage outperformed their last plan, and 46% of those previously enrolled in employer-sponsored coverage said this.

“While some Medicare Advantage plan members felt frustrated with their coverage, most enrollees expressed satisfaction with their benefits. Many even said Medicare Advantage outperforms their previous coverage,” the report said.

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