Medicare Patients Don’t Need More Information —They Need Someone to Act

The American healthcare system has a default answer for patients who struggle to access care: give them more information. More pamphlets, more portals, more educational resources explaining how benefits work, how to find a specialist, how to appeal a denied claim. 

The assumption is intuitive and well-intentioned: if patients simply understood the system better, they would use it more effectively. However, for most Medicare patients, that assumption is wrong. The barrier to care isn’t knowledge. It’s execution.

The system has misdiagnosed the problem

It’s undeniably true that health literacy matters. But for Medicare beneficiaries, there’s a more fundamental challenge: the overwhelming administrative burden of actually doing something with the information you have.

Most Medicare patients know they need to see their PCP, apply for a benefit, or follow up on a referral. What they lack is the capacity to wait 45 minutes on hold to schedule an appointment, complete a 14-page application, or play phone tag between a specialist and a primary care physician just to close the loop on a single referral. These tasks require time, persistence, and a familiarity with bureaucratic systems that most patients simply do not have.

For older and disabled adults managing multiple chronic conditions, the execution burden compounds quickly. More than 60 million Americans are over age 65 today, a population projected to reach 80 million by 2030. More than one in four adults in the United States, over 70 million, report having a disability, and disability rates among younger adults are rising. They struggle not because they don’t understand their options, but because acting on those options demands more than most people can manage alone, let alone people in these specific populations.

Research confirms that Medicare beneficiaries with disabilities and limited insurance literacy face the highest rates of delayed or forgone care, underscoring that even when information gaps are addressed, access problems persist. An HHS issue brief on Medicare care navigation describes a “high degree of complexity” in managing care when multiple providers, benefits, and settings are involved, placing the emphasis on the execution burden of coordination rather than a simple lack of awareness.

The gap between knowing and doing is where care is lost

This execution gap is consistently underestimated by health systems, in part because it is largely invisible. Outcomes data captures whether care was received, not why it wasn’t. When a patient misses a follow-up appointment or fails to enroll in a benefit program, the system records the absence, not the 45-minute hold time, the confusing application, or the three unreturned phone calls that preceded it.

Secret-shopper and survey data reveal high failure rates when patients attempt to establish care or secure appointments on their own, supporting the reality that the system repeatedly loses people in the gap between knowing and doing. But this isn’t due to a lack of effort on the clinician front; studies of primary care teams show that significant time is spent on documentation, insurance interactions, referrals, and prior authorizations, with elderly and multimorbid patients requiring disproportionately more administrative effort.

Most informational interventions assume that once a patient is informed, they will self-navigate. For many Medicare patients, that assumption does not hold. The gap between knowing and doing leads to skipped appointments, medication noncompliance, delayed diagnoses, unhealthy living conditions, and avoidable hospitalizations, all driving rising costs for payers. Not because health systems didn’t give them information, but because no one helped them act on it.

Delegation is the intervention the system hasn’t scaled

There is a solution, and it isn’t new. Patient advocates have been doing this work for decades, making the call, completing the form, following up until the problem is resolved. Sometimes that advocate is a family member or friend. Sometimes it is a professional hired out of pocket. Either way, this kind of support has historically been inaccessible to most patients, available only to those with favorable personal networks or financial resources.

That is beginning to change. New CMS payment pathways introduced in recent years, including separately billable codes for Community Health Integration and Principal Illness Navigation, explicitly pay for staff who coordinate care, address social needs, and help beneficiaries navigate benefits. These pathways represent formal recognition that delegation is not a luxury but rather a necessity.

At the same time, AI-powered infrastructure is making it possible to extend the reach of human advocates without replacing them. Technology can handle error-prone administrative work like summarizing records, drafting correspondence, and surfacing relevant resources, so that advocates can focus on what actually requires a human: building trust, exercising judgment, and persisting on a patient’s behalf until the problem is solved.

Case studies from senior care navigator programs demonstrate that this approach works. When someone advocates for older adults directly, patient-reported outcomes improve. But effective delegation requires more than a chatbot or a resource list. It requires human relationships and persistence. The challenge is making that kind of dedicated support available to the tens of millions of Medicare beneficiaries who need it.

The opportunity ahead

Health literacy is a worthy goal, but an insufficient solution. The Medicare population does not need more pamphlets, portals, or educational materials. They need action-oriented support: someone who will make the call, complete the form, and follow up until the problem is resolved. New CMS reimbursement codes have set the catalyst, creating a payment pathway that recognizes this work as essential. Now the harder work begins: building the infrastructure to ensure every Medicare patient has the help they need to clear the gap between knowing and doing.

Photo: designer491, Getty Images

This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.