RISE summarizes recent research on Medicare and Medicare Advantage.
J.D. Power: Poor member digital experience weighs heavily on health insurers
Health insurance members across both commercial and Medicare Advantage plans are increasingly using their health plan’s websites and mobile apps as their primary conduits of communication, but the quality of these digital experiences is lagging far behind what they have come to expect from other industries they interact with digitally such as financial services, property and casualty insurance, and automotive finance.
According to the J.D. Power 2025 U.S. Healthcare Digital Experience Study.SM the websites and digital apps provided by commercial member health plans and Medicare Advantage plans are routinely missing the mark on ease of navigation, ability to review coverage, and several other basics of the digital experience.
The study, conducted from August through December 2024, is based on evaluations from 6,259 members of the 15 largest Medicare Advantage plans and 15 largest commercial member health plans in the United States.
“So many daily interactions with service providers are successfully managed digitally, resulting in continually higher customer expectations for a world-class digital experience,” said Eric McCready, director of digital solutions at J.D. Power, in an announcement. “However, health insurance providers have a lot of work to do to close the gap to other industries. The most important factors driving member satisfaction with mobile apps and websites include making it easy to find the information they need; providing clear explanations of deductibles and out-of-pocket spending; and offering intuitive navigational elements. Many plans are simply not delivering on those basics."
According to the study:
- Health insurance mobile app experience lags other service industries: On average, customer satisfaction with apps is 653 (on a 1,000-point scale) among commercial member health plans and 597 among Medicare Advantage plans. Comparatively, customer satisfaction with apps is significantly higher in three other industries in which J.D. Power conducts studies: full-service wealth management companies (794); property and casualty insurers (700); and automotive finance companies (672).
- Digital experience affects satisfaction and intent to renew: Among commercial member health plan digital experiences in which overall satisfaction scores are 801 or higher, 58 percent of members are likely to have a much more positive impression of their employer. Among Medicare Advantage plan digital experiences in which overall satisfaction scores are 801 or higher, 85 percent of members say they “definitely will” renew with their current plan, which is more than double the intended loyalty rate for those digital experiences with scores of 500 or less.
- Missing basics of ease of use and navigation: The most important factor driving satisfaction with both commercial health plans and Medicare Advantage plans is ease of finding information needed. When that basic criterion is met, overall member satisfaction rises 83 points. Yet, health plans are failing to deliver that level of digital experience 39 percent of the time.
- Mobile apps show promise—when they work: The percentage of commercial health plan members who have used their insurer’s mobile app within the past year rises to 37 percent in 2025, up from 31 percent in 2024, and overall satisfaction is highest (636) among those who use the mobile app when compared with a website (607) or phone (607). However, when members have a poor digital experience, their likelihood of reusing that channel again in the future falls to just 27 percent.
- Study rankings: Researchers found that Cigna Healthcare ranks highest in satisfaction among commercial member health plans with a score of 683. Kaiser Foundation Health Plan (680) ranks second and Centene (664) ranks third. Among Medicare Advantage plans, UPMC Health Plan ranks highest in satisfaction among Medicare Advantage plans with a score of 687. UnitedHealthcare (650) ranks second and Cigna Healthcare (644) ranks third.
Study examines savings, long-term impact of ACOs in Medicare Shared Savings Program
A new study, conducted by Weill Cornell Medicine researchers and published in JAMA, finds that accountable care organizations (ACOs) that participate in the Medicare Shared Savings Program have saved Medicare between $4.1 billion and 8.1 billion from 2012 through 2019. The study is thought to be the first to investigate the long-term impact of the program, Weill Cornell Medicine said in an announcement.
Researchers compared medical spending for more than eight million Medicare patients who were treated either by ACOs or other health care organizations.
“We found a significant reduction in spending per patient with providers working together as ACOs compared with organizations that were not in ACOs, and that reduction in spending increased over time,” said senior author Dhruv Khullar, M.D., associate professor of population health sciences at Weill Cornell Medicine and a hospitalist at NewYork-Presbyterian/Weill Cornell Medical Center.
The study showed that the Medicare Shared Savings program generated a large savings, and that the savings grew over time. Compared with costs for patients in non-ACOs, ACO per-patient costs were lower by an average of $142 in the first three years of the program. After six years in the program, ACOs saved even more—an average of $294 per patient—than non-ACOs. The study also found that smaller ACOs and those led by physician groups were more effective at lowering costs than larger ACOs or those affiliated with hospitals. Regardless of the size or leadership, ACO spending reductions increased over time.
Overall, the program saved the government billions of dollars during the study period. "There's an ongoing national debate that has been re-energized because many value-based payment programs are either being cut short or haven't shown that much improvement," said lead author Amelia Bond, Ph.D., associate professor of population health sciences at Weill Cornell Medicine. "This work is important because it shows, in this longer-term view, that ACOs in the Medicare Shared Savings Program have been saving money."
Despite the savings, Dr. Khullar said more work is needed to understand the quality of medical care provided by ACOs. The research team plans to examine the effect of ACOs on care quality in their next study. They also hope to examine how quality of care varies for different patient subgroups within the overall population of patients in ACOs.
Research examines how MA growth has changed the delivery of home health care
A recent study published by Sage Journal’s Medical Care Research and Review examines the shifting patters of home health care use from 2010 to 2020. Home health use was higher among traditional Medicare enrollees but fell for both community-initiated and post-discharge needs. Meanwhile, home health use is growing among Medicare Advantage members but is typically shorter in duration of care compared to those in traditional Medicare.
In an article published by Penn LDI, lead author Rachel M. Werner, M.D., Ph.D., executive director of Penn LDI, discussed the findings and the implications for equity, access, and long-term care policy. She noted that the growth of Medicare Advantage is changing how home health care is delivered. However, it’s still unclear how the services are authorized, how care plans are structured, and whether they improve patient outcomes.
Dr. Werner said that there may be an increase in the use of home health care to fill gaps in a long-term care system that remains fragmented and underfunded, especially for those who are not dually eligible and lack access to Medicaid-funded home- and community-based services. The next step in research is understanding how the changes in home health use among Medicare Advantage members affect patient outcomes. “We know that MA plans increasingly use home health services, often in shorter episodes and with different provider networks than TM. However, we still do not know whether this care meets patients’ needs, improves their health, or reduces avoidable hospitalizations and institutional stays,” she told Penn LDI.
New Medicare program could dramatically improve affordability for cancer drugs–if patients enroll
A new study, published in JCO Oncology Practice, finds that the Medicare Prescription Payment Plan (MPPP) could help patients avoid large out-of-pocket payments for their first oral cancer prescription.
Changes in Medicare Part D, introduced by the Inflation Reduction Act (IRA) that took effect in 2025, caps annual out-of-pocket drug costs for all beneficiaries at $2,000. However, researchers from the Perelman School of Medicine at the University of Pennsylvania, find an overlooked voluntary program that’s part of the IRA could be the key to improving affordability for Medicare patients needing expensive oral cancer drugs.
“High out-of-pocket costs often put these critical medicines out of reach and can lead to patients abandoning treatment,” said study lead author Jalpa Doshi, Ph.D., Leon Hess professor in internal medicine and senior fellow at the Leonard Davis Institute of Health Economics, in an announcement. “The annual out-of-pocket maximum and MPPP together make it possible for Medicare Part D beneficiaries to greatly reduce these costs, on an annual and monthly basis.”
Researchers calculated Medicare patient out-of-pocket costs for cancer drugs taken orally under different scenarios:
- The standard Medicare Part D benefit prior to any changes
- The new annual Part D out-of-pocket maximum introduced by the IRA
- The annual out-of-pocket maximum plus patient enrollment in the voluntary MPPP permits patients to spread out-of-pocket costs throughout the year in monthly payments
Before the IRA was implemented, annual out-of-pocket costs for an oral cancer drug could run more than $11,000, much of that due early in the year, whereas in 2025 the IRA would limit these costs to $2,000 annually, according to the research team. MPPP enrollment in January would allow this annual total to be spread across 12 monthly payments, each $167.
“Timing is everything—patients who enroll early in the year will benefit the most since they will have more months to spread the payments,” Dr. Doshi said. “Oncology providers have a critical role to play in ensuring that Medicare patients to whom they prescribe expensive oral cancer medications are aware of the MPPP and the benefits of early enrollment in the year.”
Study: MA may limit radiation treatment options for cancer, increase cost and duration of care
There are significant differences in the costs and durations of radiotherapy treatment for cancer, depending on whether a patient is insured by traditional Medicare or Medicare Advantage, according to a new study by health policy researchers at Harvard T.H. Chan School of Public Health. The findings provide the first direct comparison of radiotherapy utilization and spending between the two Medicare plans.
The study, published in JAMA Network Open, examined a nationally representative sample of medical insurance claims from 2018, identifying radiotherapy patients ages 65 and older in care for one of the 15 most common cancer types. They analyzed data from 31,563 90-day radiation treatment episodes, comparing the number of treatments, estimated spending, and types of radiation administered between traditional Medicare and Medicare Advantage beneficiaries.
The study found that Medicare Advantage patients experienced, on average, 10 percent longer treatment durations compared to their traditional Medicare counterparts, and spending for their treatments was estimated to be 4 higher. Researchers also found that Medicare Advantage patients were less likely to receive advanced therapies like proton and stereotactic radiotherapy.
"With the growing number of patients enrolling in Medicare Advantage plans, it is crucial to understand the implications for radiation therapy in comparison to traditional Medicare,” said corresponding author Miranda Lam, instructor in the Department of Health Policy and Management and member of the Healthcare Quality and Outcomes Lab, in an announcement.
Lam said that more research is needed to determine if and how differences between Medicare Advantage and traditional Medicare impact quality of life or survival for cancer patients.