Majority of Medicare Advantage enrollees don't fully understand their plan

Most Medicare Advantage (MA) beneficiaries are satisfied with their health plan, but many enrollees feel they are overbilled, have struggled navigating the prior authorization process or are confused by the features of their plan, a new survey from Retirement Living recently revealed.

The survey found that 71% of beneficiaries are satisfied with their MA plan, with most people choosing a MA plan due to the plan's affordable costs and out-of-pocket expenses. Other factors that contributed to the decision included coverage of prescription drugs, access to providers and the ability to choose a doctor, comprehensive coverage options and medical and preventive care options.

In addition, 61% of people said their MA plan outperforms their previous coverage plan.

However, only 44% of MA enrollees say they fully understand their plan, with 68% saying certain details have caused confusion. Dental coverage was the most reported area of confusion, followed by out-of-pocket costs, transportation to medical appointments, caregiver support services, home health services and vision and hearing coverage. At least 20% of beneficiaries said they didn’t understand one or more of these plan elements.

Other respondents believed a lack of familiarity with the plan (56%) caused confusion, while some (44%) believed there was inadequate communication and education about benefits offered. More than 1 in 4 beneficiaries reported paying out-of-pocket costs for services they believed were covered by their plan, while 1 in 10 said they thought were overbilled for their MA plan.

Some MA enrollees felt unsatisfied by various elements of their plan, including telehealth services, online and mobile app management and chronic disease management programs, while almost 20% of respondents said they experienced delays in care caused by the prior authorization process.

Of the nearly 1 in 10 enrollees who thought they might switch coverage plans in the next year, 50% cited cost and 39% wanted to switch provider networks.

Recent studies have highlighted the positive impacts of MA plans for enrollees, including a report from the Elevance Health Public Policy Institute that found 83% of dual-eligible and 75% of non-dual-eligible individuals used at least one supplemental benefit a year. The analysis concluded that MA enrollees find value in plans when they need to meet personalized needs.

MA plans are also more popular with individuals from marginalized backgrounds. Analysis from ATI Advisory showed that a higher percentage of Black, Latino and Asian enrollees choose MA than fee-for-service plans. The report showed that MA beneficiaries also tend to live in more socially vulnerable counties.

Retirement Living surveyed 351 beneficiaries, asking them about premiums, customer service and provider networks. The median age of respondents was 69 years old.