Seven in Ten Medicare Beneficiaries Did Not Compare Plans During Past Open Enrollment Period

Each year, people with Medicare can review their coverage options and change plans during the open enrollment period (October 15 to December 7). Medicare beneficiaries with traditional Medicare can compare and switch Medicare Part D stand-alone drug plans or join a Medicare Advantage plan, while enrollees in Medicare Advantage can compare and switch Medicare Advantage plans or elect coverage under traditional Medicare with or without a stand-alone drug plan. Beneficiaries have no shortage of plans to choose from: in 2021, the average Medicare beneficiaries can choose among 33 Medicare Advantage plans and 30 Part D stand-alone prescription drug plans (PDPs).

Coverage and costs vary widely among both Medicare Advantage plans and Part D prescription drug plans. Plans can change from one year to the next, which could lead to unexpected and avoidable costs, and disruptions in care for beneficiaries who do not review their options annually. For example, provider network changes could mean beneficiaries lose access to their preferred doctors, while changes in the list of covered drugs and cost-sharing requirements could result in higher out-of-pocket drug costs. Further, beneficiaries’ health care needs can change from one year to the next, making it even more important to compare coverage options annually. Even without a change made by their plan or a change in health status, beneficiaries may be able to find a plan that better meets their individual needs. The Centers for Medicare & Medicaid Services (CMS) recommends that beneficiaries review and compare Medicare plans each year.

This analysis builds on our prior KFF work to examine the share of Medicare beneficiaries who compared plans during the 2018 open enrollment period for coverage in 2019, the share who compared drug coverage in Medicare Advantage and stand-alone drug plans, and variation by demographic characteristics, based on an analysis of the 2019 Medicare Current Beneficiary Survey (the most recent year available). All reported results are statistically significant.

Findings

7 in 10 (71%) Medicare Beneficiaries Did Not Compare Medicare Plans During the 2018 Open Enrollment Period

With the large number of Medicare private plans – Medicare Advantage and stand-alone Medicare prescription drug plans – offered each year in addition to traditional Medicare, beneficiaries have the opportunity to reassess their coverage each year during the Medicare open enrollment period. Traditional Medicare beneficiaries can compare and switch Medicare Part D stand-alone drug plans or decide to enroll in a Medicare Advantage plan, and can also evaluate Medigap supplemental insurance plans, known as Medigap. Enrollees in Medicare Advantage can similarly compare and switch Medicare Advantage plans or decide to receive coverage under traditional Medicare with or without a stand-alone drug plan and with or without Medigap.

In 2019, 71% of all Medicare beneficiaries reported that they did not compare their plan to other Medicare plans that were available during the 2018 open enrollment period, while 29% of all Medicare beneficiaries reported that they compared Medicare plans (Figure 1; Table 1). Among beneficiaries in Medicare Advantage plans, 68% reported that they did not compare Medicare plans during the 2018 open enrollment period, compared to 73% of those in traditional Medicare (Table 1).

Figure 1: 7 in 10 Medicare Beneficiaries Did Not Compare Medicare Plans During the 2018 Open Enrollment Period for their 2019 Coverage​

The share of all Medicare beneficiaries who said they did not compare Medicare plans during the 2018 open enrollment period was higher among Black (74%) and Hispanic (79%) beneficiaries, beneficiaries ages 85 and older (84%) and under age 65 with disabilities (77%), and beneficiaries with lower incomes (85%), fewer years of education (e.g., 82% for those with less than a high school education), living in rural areas (73%), those in relatively poor health (74%), and those enrolled in both Medicaid and Medicare (e.g., 87% for full-dual eligibles) (Figure 2).

Most Beneficiaries in Medicare Advantage Drug Plans and Stand-alone Drug Plans Did Not Compare Drug Coverage in 2019

In 2019, 8 in 10 (81%) beneficiaries in Medicare Advantage drug plans (MA-PDs) said they did not compare the drug coverage offered by their current MA-PD plan to any other MA-PD in their area (Figure 3; Table 2). Among stand-alone drug plan (PDP) enrollees, more than 7 in 10 (72%) said they did not compare drug coverage offered by their current PDP to other PDPs.

Figure 3: Most Enrollees in Medicare Advantage Drug Plans and Stand-alone Drug Plans Did Not Compare Plans in 2019​

The share of beneficiaries in both types of drug plans who did not compare drug coverage in 2019 was higher among those who are Hispanic (88% of MA-PD and 85% of PDP enrollees), ages 85 and older (90% of MA-PD and 80% of PDP enrollees), with incomes under $10,000 (87% of MA-PD and 81% of PDP enrollees), and those enrolled in both Medicaid and Medicare (e.g., 91% of MA-PD and 87% of PDP full-dual eligibles) (Table 2).

Medicare’s Website, Toll-Free Number, and Handbook Are Not Widely Used by Beneficiaries

  • Nearly half (47%) of all beneficiaries with Medicare said they had never visited the official Medicare website for information, while 42% said they said they (or someone for them) had ever visited the website, and the remainder (11%) reported they did not have access to the internet or had no one to access it for them (Figure 4).
  • 53% of all Medicare beneficiaries reported they had never called the 1-800-MEDICARE helpline for information, while 31% reported they had ever called the helpline, and another 16% said they were not aware this helpline existed.
  • Half (51%) of Medicare beneficiaries reported they had read thoroughly or some parts of the Medicare & You handbook, while almost one-third (31%) reported they had not read it at all. Nearly one in five (18%) Medicare beneficiaries reported they did not receive it or did not know if they had received it.

Figure 4: Medicare’s Website, Toll-Free Number, and Handbook Are Not Widely Used by Beneficiaries​

The share of Medicare beneficiaries who did not use Medicare information sources varied among subgroups of beneficiaries (Table 3). For example, a larger share of Black (52%) beneficiaries than White (46%) never visited the Medicare.gov website. Additionally, 52% of beneficiaries with incomes under $10,000 did not visit the Medicare.gov website, compared to 41% among those with incomes greater than $40,000. Over one in three (39%) beneficiaries enrolled in Medicaid and Medicare read the Medicare & You handbook compared to 53% of those not enrolled in Medicaid and Medicare.

Discussion

The marketplace of Medicare private plans operates on the premise that people with Medicare will generally compare plans to select the best source of coverage, given their individual needs and circumstances. This analysis finds that most Medicare beneficiaries did not compare plans during the 2018 open enrollment period for coverage in 2019, and most people in stand-alone drug plans and Medicare Advantage drug plans did not compare the drug coverage offered by their PDP or MA-PD to other drug plans in 2019.

We also find that beneficiaries who may be more likely to be affected by plan changes from one year to the next, such as older beneficiaries, beneficiaries who are under age 65 with disabilities, and those in worse health, were the least likely to report comparing plans during the 2018 open enrollment period for their 2019 coverage, which can lead to higher out-of-pocket costs and disruptions in care. Additionally, our analysis finds that beneficiaries who are Black and Hispanic, with low incomes, and fewer years of education were less likely to compare plans during the 2018 open enrollment period.

This analysis builds on previous KFF analyses which suggest that the marketplace of Medicare plans may not be working as intended. Previous KFF analyses have shown that more than half of Medicare beneficiaries do not compare or review their Medicare health coverage options annually and that a small share of Medicare beneficiaries voluntarily switch plans. This “stickiness” could suggest beneficiaries are satisfied with their current coverage. However, past KFF analysis, based on focus groups, has revealed that while many Medicare beneficiaries know about the open enrollment period and are generally aware that they should compare plans, many also find the process of comparing plans challenging.

With a growing number of Medicare private plan choices available each year, the fact that such a large share of seniors and people with disabilities report not comparing plans during the open enrollment period warrants attention, given the potential consequences of year-to-year plan changes for their coverage, access to care, and out-of-pocket costs.

Methods
This analysis uses survey data for community-dwelling Medicare beneficiaries from the Centers for Medicare & Medicaid Services (CMS) Medicare Current Beneficiary Survey (MCBS) 2019 Survey File.

The analysis of plan comparison during open enrollment and use of Medicare information sources used questions from the Medicare Plan Beneficiary Knowledge topical segment, and the analysis was weighted to represent the ever-enrolled Medicare population in 2019 using the topical survey weight KNSEWT and relevant replicate weights. This analysis excludes beneficiaries who reported just enrolling in Medicare.

The analysis of MA-PD/PDP drug plan comparison used questions from the RX Medication topical segment; similar as above, the analysis was weighted to represent the ever-enrolled Medicare population in 2019 using the topical survey weight RXSEWT and relevant replicate weights.

Both analyses exclude beneficiaries with Part A or Part B only and those with Medicare as secondary payer. Results from all statistical tests were reported with p<0.05 are considered statistically significant.

Tables

Topics

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