New research from the Commonwealth Fund explores the role agents play in influencing Medicare beneficiary plan choices. But without financial incentives, agents don’t’ necessarily offer information on Medicare Advantage plans not in their contracts.

Online broker plan selection tools may actually limit Medicare beneficiaries ability to make an informed choice about their health coverage, according to a new Commonwealth Fund study, which explored the role agents play in influencing seniors choice of Medicare plans and identified ways to improve the process.

Nearly all (96 percent) Medicare Advantage and Part D plans contract with agents, who are not required to represent all available plans. But the study indicates that the agent–plan model can limit plan choice in ways that are not obvious to beneficiaries.

Researchers analyzed data from the Centers for Medicare & Medicaid Services, conducted interviews with industry experts, and conducted an online search simulation and analysis of information available through online brokerage sites regarding Medicare Advantage, Medicare Supplement, and Part D prescription plans.

A growing number of Medicare beneficiaries rely on online tools for at least part of their research and decision-making for their health care choices, according to the research. After conducting an analysis across five markets of three national, online agent plan selection tools, researchers found that on average, each online agent tool includes only 43 percent of Medicare Advantage plans and 65 percent of Part D prescription drug plans in that area. Since agents’ and insurers’ Medicare resources are widely available online, those sites are likely to be among the first information sources seen in online searchers. Indeed, in the Commonwealth Fund analysis of online searches, more than one-third of results from the first page led to agents’ or health insurers’ websites.

“Agents typically secure contracts with multiple carriers, but they are not required to contract with all available carriers in their market,” the study authors wrote. “This means that a single agent will not necessarily represent every available plan. In this way, the agent market is filtering plan options, something that may not be apparent to the beneficiary even if the agents and agencies disclose it in their communications.”

The study results indicate that much of the online information available to seniors is owned by organizations with commercial interests. This raises questions about the extent to which Medicare beneficiaries are aware of the sources, potential limitations in the information, and any potential conflicts or biases that may be inherent in the source.

"How are we making sure that when people are going through the process, whether it's through a Google-type experience, or any other digital-first shopping experience, that they understand the source that they're turning to?" Riaz Ali, lead author of the study, told Modern Healthcare. “When there is an expectation of objectivity and transparency, but they're not necessarily getting it, I think that's where there's really the rub."

Based on the analysis, researchers recommended two policy options to improve Medicare beneficiaries’ decision-making experience:

  • Increase transparency and beneficiary access to high-quality agents: This would involve creating incentives for appropriate disclosures (during in-person encounters and via online tools) of the share of plans with which an agent works, associated compensation and incentives, and other information such as education and credentials. In addition, it would create a Medicare agent marketplace with a performance rating for agents either managed at the state or federal level. This would allow seniors to search and evaluate agents based on their qualifications and beneficiary ratings.
  • Boost support of organizations that provide Medicare education, beyond just plan selection: Researchers recommend that policymakers continue to invest in to improve the resources and tools available to beneficiaries. In addition, authors said policymakers need to support existing public and not-for-profit educational efforts that focus on broader topics around Medicare and navigating Medicare beyond the individual plan choice. Enhancing these resources, which have no financial stake in plan decisions, is crucial in the existing model where beneficiaries are asked to make consequential trade-offs with imperfect information.