Abstract
BackgroundManaged care programs in the US are becoming a preferred alternative among low-income individuals in the US. Every year during open enrollment, seniors can enroll in Medicare Advantage (MA) or switch MA plans. However, there is very limited information about how seniors obtain information to help them make their choices. While the Centers for Medicaid and Medicare offer online resources that are designed to enable potential beneficiaries to make informed coverage decisions, there is no information as to whether seniors use these resources, and therefore whether these resources are effective compared to other information retrieval methods.MethodsThe purpose of the present study was to qualitatively explore how seniors obtain information about insurance plans in MA. We conducted semi-structured interviews with 26 MA beneficiaries from Rhode Island.ResultsWe found that most seniors have strong preferences for obtaining information in-person regarding benefits, cost and other plan information. Some seniors relied heavily on insurance brokers or representatives, and considered the information provided to them without questioning the potential for bias. Others consulted with family and/or friends for guidance, or to compare costs and benefits. Only a few of these seniors used the available internet resources, and in fact most of them mentioned that they did not have a computer/smart device with internet capabilities. However, among those who used and appeared to be comfortable with navigating the internet, www.medicare.gov was not discussed as a useful resource for making decisions regarding health insurance.ConclusionsThis study suggests that existing online medical resource usage and effects among senior citizens in the United States may need supplementing with in-person communication among influential agents.
Highlights
IntroductionThrough the Medicare Modernization Act of 2003, Medicare incorporated a prescription drug benefit plan (Part D), but it expanded the Medicare managed care program (Medicare + Choice) through the new Medicare Advantage (MA) program [2]
Managed care programs in the US are becoming a preferred alternative among low-income individuals in the US
In the United States, when seniors turn 65 and/or are eligible for Medicare, they need to make a number of choices and enrollment decisions including whether to enroll in traditional Medicare (Parts A and B), prescription drug coverage (Part D), supplemental coverage to pay for additional costs not covered by traditional Medicare, or whether they will get coverage through Medicare Advantage (Part C) instead [1]
Summary
Through the Medicare Modernization Act of 2003, Medicare incorporated a prescription drug benefit plan (Part D), but it expanded the Medicare managed care program (Medicare + Choice) through the new Medicare Advantage (MA) program [2] This brought several changes to the program, including a revised payment methodology adjusting for enrollees’ hierarchical chronic condition, lock-in restrictions and more restrictive networks of healthcare providers [3]. MA plans are compensated or penalized based on their quality and allowing MA plans to incorporate benefits and services that address social determinants of health for people with complex conditions [4] These changes in the MA program bolstered enrollment, which has reached over 22 million of beneficiaries, or 34% of all Medicare enrollees [5]. Prior research has shown that MA may attract healthier beneficiaries and may not meet the care preferences of beneficiaries with complex needs, which encourages high-need beneficiaries to disenroll from MA [9]
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