The decision by most of the nation’s 67 million Medicare beneficiaries not to compare plans could have a significant impact on enrollee’s coverage and costs.
The new KFF analysis shows that nearly seven in 10 Medicare beneficiaries (69 percent) did not compare their Medicare coverage with other Medicare options during the program’s annual open enrollment period for coverage in 2022. Enrollees in traditional Medicare were slightly more likely to skip shopping around than those in Medicare Advantage (MA) plans (73 percent vs. 65 percent).
MA member shopping habits
The new report, which used data from the Centers for Medicare & Medicaid Services (CMS) 2022 Medicare Current Beneficiary, looked at the share of Medicare beneficiaries who reviewed their coverage and compared plans during the 2021 open enrollment period for coverage in 2022 and who made use of Medicare’s official information resources.
Among MA enrollees:
· Forty-three percent of enrollees did not review their own plan’s coverage during the open enrollment period to see whether there would be changes for 2022 to their monthly premiums, deductibles, co-payments, or other out-of-pocket expenses.
· The share not reviewing their own plan for changes in costs was higher among enrollees in fair or poor self-assessed health (50 percent), enrollees who are Black (50 percent) or Hispanic (65 percent), and enrollees ages 85 and older (57 percent).
· Forty-four percent of MA enrollees did not review their current plan for changes to the kinds of treatments, drugs, and services offered for 2022.
· Eighty-two percent of enrollees in MA prescription drug plans and 69 percent in stand-alone prescription drug plans did not compare their plan’s drug coverage with drug coverage offered by other plans in their area.
Medicare beneficiaries also don’t take advantage of official information resources. The study found:
· Only a quarter (26 percent) reported calling the toll-free 1-800-Medicare helpline
· Four in 10 (42 percent) reported visiting the Medicare website
· Fifty-four percent reported reading some or parts of the Medicare & You handbook
Why shopping for plans matters
CMS encourages Medicare beneficiaries to compare their options during the open enrollment period, which runs October 15 through December 7, because costs and coverage options vary widely, especially among MA plans. From one year to the next, MA plans can change their premiums, cost-sharing requirements, provider networks, or prior authorization requirements. For beneficiaries who simply stay put in their existing plan, such changes could lead to unexpected, avoidable costs and disruptions in care, study authors said.
New changes for 2025 include prescription drug provisions in the Inflation Reduction Act of 2022 that will lower out-of-pocket costs for all Part D enrollees, including a new $2,000 cap on out-of-pocket spending starting in January. KFF authors noted that in response, Part D plan sponsors may make changes to plan premiums, formularies, and cost sharing—making it especially important for beneficiaries to compare their prescription drug options during open enrollment.