Annually, folks with Medicare can overview their protection choices and alter plans in the course of the annual Open Enrollment Interval (October 15 to December 7). Medicare beneficiaries with conventional Medicare can examine and swap Medicare Half D stand-alone drug plans or be part of a Medicare Benefit plan, whereas enrollees in Medicare Benefit can examine and swap Medicare Benefit plans or elect protection underneath conventional Medicare with or with out a stand-alone drug plan. Beneficiaries haven’t any scarcity of plans to select from: in 2024, the typical Medicare beneficiary can select amongst 43 Medicare Benefit plans and 21 Half D stand-alone prescription drug plans (PDPs).
{The marketplace} of Medicare non-public plans operates on the premise that folks with Medicare will examine plans in the course of the open enrollment interval to pick one of the best supply of protection, given their particular person wants and circumstances. Protection and prices range broadly amongst each Medicare Benefit plans and Half D prescription drug plans and might change from one yr to the subsequent, which might result in surprising and avoidable prices and disruptions in look after beneficiaries who don’t overview their choices yearly. For instance, modifications in Medicare Benefit supplier networks might imply beneficiaries lose entry to their most popular docs, whereas modifications within the record of lined medicine and cost-sharing necessities might lead to greater out-of-pocket drug prices. Additional, beneficiaries’ well being care wants can change from one yr to the subsequent. Even with out a change made by their plan or a change in well being standing, beneficiaries could possibly discover a plan that higher meets their particular person wants or lowers their out-of-pocket prices.
In focus teams carried out by KFF, Medicare beneficiaries highlighted many of those components, together with out-of-pocket prices, entry to particular docs, and protection of pharmaceuticals, as necessary in selecting their Medicare protection. But, Medicare beneficiaries additionally expressed issue understanding and evaluating the assorted plan choices and being overwhelmed by a barrage of tv advertisements – largely for Medicare Benefit plans.
On this evaluation, KFF examines the share of Medicare beneficiaries who reviewed their protection and in contrast plans in the course of the 2021 open enrollment interval for protection in 2022, and who made use of Medicare’s official data sources, in addition to variations by demographic teams, based mostly on an evaluation of the 2022 Medicare Present Beneficiary Survey (the latest yr out there).
Key Takeaways
General, almost 7 in 10 (69%) Medicare beneficiaries didn’t examine their very own supply of Medicare protection with different Medicare choices supplied of their space in the course of the 2021 open enrollment interval, whereas 31% did so. A bigger share of beneficiaries in conventional Medicare than in Medicare Benefit didn’t examine their very own supply of protection with different plans (73% vs 65%).
Amongst Medicare Benefit enrollees, greater than 4 in 10 (43%) didn’t overview their present plan’s protection to verify for potential modifications of their plan’s premiums or different out-of-pocket prices, whereas the rest (57%) did so. The same share (44%) didn’t overview their present plan for potential modifications within the sorts of remedies, medicine, and companies that might be lined within the following yr.
Most enrollees in Medicare Benefit prescription drug plans (82%) and stand-alone prescription drug plan (PDPs) (69%) didn’t examine their plan’s drug protection with drug protection supplied by different plans of their space.
Medicare’s official data sources are utilized by half or fewer of Medicare beneficiaries, with only a quarter (26%) reporting calling the toll-free quantity, 4 in 10 (42%) reporting visiting the Medicare web site, and barely greater than half (54%) reporting studying some or components of the Medicare & You handbook.
Almost 7 in 10 Medicare Beneficiaries Did Not Evaluate Medicare Protection Choices Through the Open Enrollment Interval for 2022
General, most (69%) Medicare beneficiaries reported that they didn’t examine their present Medicare plan to different Medicare protection choices that had been out there in the course of the 2021 open enrollment interval for protection in 2022 (Determine 1, Desk 1). Amongst Medicare Benefit enrollees, almost two-thirds of enrollees (65%) didn’t examine protection choices for 2022, though year-to-year modifications in Medicare Benefit plans, reminiscent of modifications in supplier networks or prior authorization necessities can have an effect on enrollees’ entry to care.
The share of Medicare beneficiaries who didn’t examine Medicare protection preparations was greater amongst sure subgroups, together with beneficiaries with decrease incomes and schooling ranges, Hispanic beneficiaries, these dually-enrolled in Medicare and Medicaid, underneath age 65 with disabilities or ages 85 and older, and beneficiaries with a cognitive impairment (Determine 2, Appendix Desk 1).
Extra Than 4 in 10 Medicare Benefit Enrollees Did Not Evaluate Their Personal Plan for Potential Modifications in Lined Prices or Providers for the Coming 12 months
For Medicare Benefit enrollees, premiums, value sharing, and out-of-pocket limits can range from yr to yr and throughout plans, with Medicare Benefit plans having the pliability to switch value sharing for many companies, topic to limitations. Medicare Benefit plans could present further (“supplemental”) advantages that aren’t lined in conventional Medicare, however the sort and scope of particular companies typically varies from one yr to the subsequent. Moreover, nearly all Medicare Benefit enrollees are in plans that impose prior authorization necessities for sure companies, and these plans can alter the record of lined medicine, and broaden or slender their community of physicians and different suppliers from one yr to the subsequent, topic to federal requirements.
Greater than 4 in 10 (43%) Medicare Benefit enrollees didn’t overview their present plan in the course of the open enrollment interval to see whether or not there could be modifications for 2022 to their month-to-month premiums, deductibles, co-payments, or different out-of-pocket bills, however the remaining 57% reported doing so (Determine 3, Appendix Desk 2). Equally, 44% of Medicare Benefit enrollees didn’t overview their present plan for modifications to the sorts of remedies, medicine, and companies supplied for his or her protection in 2022.
The share of Medicare Benefit enrollees who didn’t overview their very own plan for modifications in prices or companies was greater amongst sure enrollees, together with these with decrease incomes and schooling ranges, Black and Hispanic enrollees, people self-reporting truthful or poor well being, enrollees ages 85 and older, and people dually-eligible for Medicare and Medicaid protection (Determine 3, Appendix Desk 2).
For instance, half of all Medicare Benefit enrollees reporting truthful or poor well being didn’t verify to see if there was going to be a change in month-to-month premiums, deductibles or co-payments of their protection, or any change within the sorts of remedies, medicine and companies that might be lined. Almost two-thirds of Hispanic (65%) and half of Black (50%) Medicare Benefit enrollees didn’t overview their plan for modifications in prices, with an identical sample for modifications in companies (64% vs 48%, respectively). Moreover, almost 60% of adults ages 85 and older didn’t overview their plan for modifications in prices (57%) or companies (58%).
Most Medicare Beneficiaries with Half D Prescription Drug Protection Did Not Evaluate Their Plan’s Drug Protection to Different Drug Protection Choices
Half D plan prices, together with premiums, deductibles, and cost-sharing necessities can change from yr to yr and range by plan. Moreover, Half D plans can even modify their formularies, together with including or dropping medicine from protection, and including or modifying utilization administration necessities that apply to particular medicine, reminiscent of prior authorization and step remedy.
The prescription drug provisions of the Inflation Discount Act embrace modifications that can decrease out-of-pocket prices for all Half D enrollees, together with a brand new $2,000 cap on out-of-pocket spending beginning in 2025. In response to those modifications, it’s potential that Half D plan sponsors could make modifications to plan premiums, formularies and price sharing, making it notably necessary for beneficiaries to check their prescription drug choices throughout open enrollment.
About 8 in 10 (82%) enrollees in Medicare Benefit plans with prescription drug protection (MA-PDs) didn’t examine the drug protection supplied by their very own MA-PD to different MA-PDs of their space in the course of the 2021 open enrollment interval (Determine 4; Appendix Desk 3). Amongst stand-alone prescription drug plan (PDP) enrollees, a decrease share, 69% of enrollees, stated they didn’t examine drug protection supplied by their present PDP to different PDPs.
The share of beneficiaries with protection underneath MA-PDs or PDPs who didn’t examine drug protection supplied for protection in 2022 was greater amongst girls, beneficiaries with decrease incomes and schooling ranges, Hispanic beneficiaries, beneficiaries ages 85 and older, and dual-eligible people (Appendix Desk 3).
Medicare’s Info Sources Are Utilized by Half or Even Fewer Beneficiaries
Medicare supplies data sources to assist beneficiaries perceive their Medicare advantages, protection choices, and prices, together with the 1-800 Medicare toll free quantity, the Medicare.gov web site, and the Medicare & You handbook that’s offered annually to all Medicare beneficiaries. However these sources will not be broadly used, notably the toll-free quantity (Determine 5, Appendix Desk 4).
A couple of quarter (26%) of Medicare beneficiaries reported calling the 1-800-MEDICARE helpline for data, however the remaining three-quarters (74%) of Medicare beneficiaries reported both by no means calling the helpline for data (51%) or being unaware that this helpline existed (23%).
4 in 10 (42%) Medicare beneficiaries stated they (or somebody on their behalf) visited the official Medicare web site for data, however greater than half (58%) stated they both by no means visited the web site (36%) or they didn’t have entry to the web or had nobody to entry it for them (22%).
Greater than half (54%) of Medicare beneficiaries reported that they’d learn the Medicare & You handbook (completely or some components of the handbook), however 46% reported that both they didn’t learn the handbook (31%) or they didn’t obtain it or didn’t know if they’d acquired it (15%).
The share of Medicare beneficiaries who used Medicare data sources was decrease amongst sure subgroups, together with Black beneficiaries, people ages 75 to 84, and dual-eligible people (Appendix Desk 4).
Strategies
This evaluation makes use of survey information for community-dwelling Medicare beneficiaries from the Facilities for Medicare & Medicaid Providers (CMS) Medicare Present Beneficiary Survey (MCBS) 2022 Survey File.
The evaluation of 1) the share of beneficiaries who in contrast Medicare plans in the course of the open enrollment interval for 2022 protection, 2) the share of Medicare Benefit enrollees who reviewed their present protection for modifications in prices or companies, and three) the share of beneficiaries who used Medicare’s official data sources used questions from the Medicare Plan Beneficiary Data topical section. This evaluation was weighted to signify the ever-enrolled Medicare inhabitants in 2022 utilizing the topical survey weight KNSEWT and related replicate weights. The evaluation of the share of beneficiaries who in contrast Medicare plans and the share of Medicare Benefit enrollees who reviewed their present protection for modifications in prices or companies excluded beneficiaries who reported simply enrolling in Medicare.
The evaluation of MA-PD/PDP drug plan comparability used questions from the Rx Treatment topical section; related as above, the evaluation was weighted to signify the ever-enrolled Medicare inhabitants in 2022 utilizing the topical survey weight RXSEWT and related replicate weights.
Each analyses excluded beneficiaries with Half A or Half B solely, these with Medicare as secondary payer, and people residing in long-term care services. All reported variations within the textual content are statistically vital at p<0.05.
