Study: Only Half of Medicare Advantage Members Understand Their Plan

Philip Betbeze, August 10, 2017

Integration and care coordination are key dissatisfiers for members of Medicare Advantage plans, and insurers are missing a huge opportunity for growth, says a J.D. Power study.

Although members are more satisfied overall with their Medicare Advantage plans in 2017, still only slightly more than half of members (54%) completely understand how their plan works, according to a newly released J.D. Power study on Medicare Advantage plans.

And even though enrollment has been growing steadily—more than 33% of all Medicare beneficiaries are now enrolled in Medicare Advantage--the study found that health plans are missing a significant pre-marketing opportunity for the over-60 age group, many of whom will transition to Medicare by age 65.

In fact, the proportion of the population age 65+ in the U.S. is projected to increase from 14% to 21% over the next 20 years, which represents an opportunity for plans to capture market share as more people become Medicare-eligible. However, the survey found that only 11% of members in the 60+ age cohort had received any communications from their health plan regarding moving from current coverage to a Medicare Advantage plan.

Among the 11% who have received premarketing contact from their health plan, overall satisfaction scores are 52 index points higher than among those who received no marketing contact (762 vs. 710, respectively, on a 1,000-point scale). Also, fewer members understand how their prescription drug coverage works than they did last year.

“Medicare Advantage plans represent a significant growth opportunity, but many health plans are not maximizing that potential,” said Valerie Monet, senior director of the insurance practice at J.D. Power, in a press release.

Member responses indicated that progress can be made in satisfaction levels in part by better coordination of care by health plans. Only 34% of members indicated that their plan was able to effectively help them with care coordination.

Another big factor in member satisfaction is the degree to which members see their doctor as a trusted partner in their medical care. Though health plans may have limited impact on this factor, the issue is related not so much to the soft skills of the clinician, but with assistance in navigating the myriad of healthcare providers involved in their care and managing the associated costs, suggesting a role for health plans.

Overall member satisfaction in 2017 held steady with an average score of 799, which is nine points higher than the same study found in 2016. This is the third year of the study for the global market research company, which is based on survey responses from 3,442 Medicare Advantage members from the 12 largest Medicare Advantage plans from around the country.

It measures satisfaction based on six factors (in order of importance): coverage and benefits (25%); customer service (19%); claims processing (15%); cost (14%); provider choice (14%); and information and communication (12%). 

Kaiser Permanente ranks highest in Medicare Advantage member satisfaction for a third consecutive year, with a score of 852, which is 49 points higher than the second-ranked plan.

Kaiser outperforms all other plans across five of the six factors that comprise the overall satisfaction index. Highmark ranks second with a score of 803 and Humana ranks third with a score of 794.

Philip Betbeze

Philip Betbeze is the senior leadership editor at HealthLeaders Media.

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