Medicare

Part
01
of three
Part
01

Perceptions of Medicare

Many people (25%) perceive the choice "between Medicare Advantage and traditional Medicare" as a difficult decision. A sizable quantity of Baby Boomers (26%) "feel 'nervous' about enrolling" in Medicare. Feeling confused about Medicare is a top concern among those considering Medicare, as over 70% of those surveyed wanted to understand Medicare better.

FINDINGS

1. perceptions of medicare advantage

  • Overall, consumers have a somewhat-positive perception of Medicare Advantage, as the satisfaction score among consumers was 794/1000 in 2018. However, that value marked a slight drop from its 799/1000 level in 2017.
  • A majority of people (54%) feel they don't receive sufficient help "with managing out-of-pocket costs" involving Medicare Advantage from their plan providers.
  • A majority of people (56%) feel confident that they can obtain help when necessary with their Medicare Advantage plan from their plan providers.
  • Many people (25%) perceive the choice "between Medicare Advantage and traditional Medicare" as a difficult decision.
  • There is significant lack of awareness about Medicare Advantage even among Medicare beneficiaries, as 65% of traditional Medicare enrollees don't know about Medicare Advantage.

2. people's emotions about thinking they'll soon be on medicare

  • A sizable quantity of Baby Boomers (26%) "feel 'nervous' about enrolling" in Medicare.
  • Among Baby Boomers surveyed, 14% felt "overwhelmed" at the thought of enrolling in Medicare.
  • Over one-quarter (27%) of Baby Boomers surveyed expressed feeling indifferent about their Medicare enrollment.
  • Many Baby Boomers feel a sense of reliance/dependence/trust in the Medicare system, as three-fourths of Baby Boomers reported they hadn't included the costs of health care as part of their savings goals for retirement and, among those people, (1) 70% are relying "on Medicare to cover their health care expenses" and (2) 50% have the expectation that Medicare will cover thee costs of "their long-term care" despite the fact that Medicare's website says that many long-term care expenses that are non-medical in nature are not covered.
  • Some people (8%) "in their early 60s" have a feeling of reliance/dependence/trust in Medicare such that they are even postponing "medical procedures until theyre eligible for Medicare at age 65."

3. top concerns for those considering medicare

  • A top concern among those considering Medicare is not being able to afford to have healthcare coverage during retirement, as 45% "of pre-Medicare adults" reported that "they have little or no confidence that they’ll be able to afford health coverage once they retire."
  • Furthermore, 30% of pre-Medicare adults reported uncertainty as to whether "they would be able to afford their health insurance in the next year."
  • Choosing when to retire is another top concern among those considering Medicare, as 11% reported that they either postponed or thought about postponing their retirement in order to retain health coverage through their employers.
  • Many people are concerned about ensuring that they are indeed eligible for Medicare before retiring, as 84% responded that having health insurance is a key component in deciding when to retire and 43% responded that being eligible for Medicare is a key factor in deciding the same.
  • Feeling confused about Medicare is a top concern among those considering Medicare, as over 70% of those surveyed wanted to understand Medicare better.

your research team applied the following strategy:

We found information about perceptions of Medicare Advantage by reviewing multiple articles discussing these topics and which included surveys of people nearing the retirement age. One main source that we consulted for that was HealthPayer Intelligence. The information that we found about emotions people feel when thinking about soon being on Medicare came from surveys of Baby Boomers, as they are the generation that is and will continue to be joining Medicare for years to come. One of the sources we used for such data was Senior Concerns. We also found information about people's top concerns about considering Medicare from surveys of Baby Boomers and one such source we used for that information was AARP. For the information on the emotions people have when thinking about joining Medicare and their top concerns about joining, we focused on Baby Boomers (50s-60s) because those people would likely have thought the most about Medicare, since they are closest to the enrollment age (65), compared to younger adults in their 40s for example. Together, this research process provided us all the information we sought about the general perceptions and feelings that people in the U.S. have about Medicare.
Part
02
of three
Part
02

Top Drivers - Happiness And Advocacy: Medicare Advantage

The top drivers of happiness of a Medicare Advantage insurance provider are coverage and benefits, customer service, and claims processing. The top driver of advocacy of a Medicare Advantage insurance provider is care coordination services. Below is an overview of the findings.

1. Top drivers of happiness of a Medicare Advantage insurance provider

  • According to the JD Power Medicare Advantage study, the top happiness drivers of a Medicare Advantage insurance provider are coverage and benefits (26%), customer service (19%), claims processing (14%), cost (14%), provider choice (15%), and information and communication (13%).
  • About 54% of members opine that their Medicare plan actively works to keep out-of-pocket costs low. This is the primary driver of Medicare Advantage satisfaction.
  • Another happiness driver of Medicare Advantage plans is that private insurers provide a higher-quality of care than single government-run entities.
  • Members pay less for Medicare Advantage than they would for the "traditional fee-for-service Medicare" and this has become key happiness driver.
  • About 9 in 10 seniors are happy with their Medicare Advantage coverage plans.

2. Top drivers of advocacy of a Medicare Advantage insurance provider

  • According to the JD Power Medicare Advantage study, care coordination services have become a strong driver for advocacy of a Medicare Advantage insurance provider.
  • Seniors are moving to Medicare Advantage plans as these plans feature deductibles, co-insurance, and out-of-pocket costs, among others, and are advocacy drivers of Medicare Advantage insurance provider.
  • One advantage that Medicare Advantage insurance providers have is that the Affordable Care Act (ACA) provides bonus payments to counterbalance the decreased reimbursements.

Research Strategy

Information on the top drivers of happiness and advocacy of a Medicare Advantage insurance provider was found in reports and articles on the Medicare Advantage market (such as those published by JD Power, Forbes, Care Centrix, among others). We determined the drivers based on a report of JD Powers and noticed these drivers were mentioned in multiple articles. Furthermore, as advocacy means public support for a particular cause or policy, we have provided information for advocacy from public support or recommendation of cause.
Part
03
of three
Part
03

Medicare Part D - Challenges and Problems

Some problems faced by consumers of Medicare Part D includes increasing out-of-pocket costs, affordability, and the need for assistance when choosing plans. For providers, they face issues such as regulating the extreme use of opioids, hidden reinsurance costs, and limited incentives to avoid highest-cost medications.

Common Consumers' Medicare Part D Problems and Challenges

1. Assistance in Choosing Plans

  • A study of groups of consumers of Medicare Part D by NCBI revealed that common problems they faced were the need for increased assistance and simplicity in their choice processes. One participant in the study said, "I mean I think I have more problems with the health care thing than I do with the income tax, which is not easy."
  • Boomer Benefits' report, which supported the problems faced by consumers in the study by NCBI, observed that consumers always have issues to resolve with Medicare Part D. The report noted that 70% of its client services were on resolving issues with patients on the phone such as tier-specific deductibles, always-changing premiums, challenges with setting up Social Security deductions, and increases in premiums due to late penalties.
  • The NCBI's study of Medicare Part D participants in 2018 observed that more research was required to understand the most effective ways of assisting consumers with the decision-making, citing the need to understand the context needed to provide the most assistance to consumers.

2. Increasing Out-of-pocket costs

  • A study by AJMC in 2017 established that Medicare Part D's existing cost-sharing structure created a significant cost burden for specialty drug consumers; the study concluded that the implementation of monthly and annual out-of-pocket (OOP) maximum spend limits could yield a more consistent and lower OOP expenditures and help to increase patients' access to life-threatening diseases.
  • According to a 2019 report by the KFF Organization, Medicare Part D enrollees that were not getting low-income subsidies could pay thousands of dollars out-of-pocket for some specialty drugs in 2019. The report revealed that the median OOP expenses could go from $2,622 for Zepatier (for hepatitis C) to about $16,551 for Idhifa (for leukemia).
  • The KFF Organization's report noted that many Medicare Part D beneficiaries continued to face significant OOP costs for medications, with specialty tier reaching over $670 per month in 2019, which was a burden for enrollees.

3. Affordability issues and Limited Access to further help

  • An examination of over 16,000 questions by Medicare beneficiaries by Medicare Rights revealed that Medicare Part D enrollees faced the problem of not being able to afford the costs of their medication throughout phases of the entire Part D program.
  • Medicare Part D enrollees reported that they could not afford their medications at full costs when charged fully for them at pharmacy counters, and did not have clear explanations regarding how to ensure their plans paid for drugs, according to a study by Medicare Rights.
  • In the Medicare Part D program, beneficiaries face the challenge of not being able to request tiering exceptions, which could help to increase the affordability of drugs under this category, according to Medicare Rights' 2018 study.

Common Providers' Medicare Part D Problems and Challenges

1. Extreme use of Opioids

  • A study by the US Department of Health in 2017 underscored the excessive use of opioids among beneficiaries of Medicare Part D as a problem providers' needed to look into; the study found that one out of three Medicare Part D enrollees received an opioid prescription in 2016.
  • According to the US Department of Health's research, 500,000 of Medicare Part D beneficiaries got high amounts of opioids in 2016; the organization signified that the situation had put up to 90,000 enrollees at severe risks.
  • A report by ProPublica observed that the problem of abusing opioids, enhanced by irregular prescriptions, has been a notable problem of Medicare Part D program starting from 2013.

2. Large Hidden Reinsurance costs

  • According to a report by the New York Times in 2018, Medicare Part D's beneficiaries' out-of-pocket spending was crossing the threshold of $5,000, which was catastrophic and shifted about 80% of drug costs to another government program called reinsurance.
  • The New York Times' report observed that reinsurance spending was not reflected in the Medicare Part D premiums and was rising significant, noting that it harmed the competition the program aimed to introduce.
  • As per the report by the New York Times, the number of beneficiaries who entered the catastrophic drug cost range went up by 50%, from 2.4 million to about 3.6 million between 2010 and 2015.
  • A report by the AEI Organization found that the direct premium subsidy for Medicare Part D per enrollee was $687 while reinsurance averaged $366 in 2008, respectively; the report then revealed that reinsurance increased to $874 per beneficiary in 2017 while direct premiums fell to about $353.

3. Limited Incentive to Avoid Highest-cost drugs

  • According to a report by Foley, physicians that prescribe Medicare Part D drugs face many barriers in administering and financing care; the report also noted that about 80% of physicians said that the duration required to identify a beneficiary's coverage and cover claims created hurdles to administer Medicare Part D vaccines.
  • Brookings 2017 report of challenges faced in the Medicare Part D program revealed that the US government's shielding of private insurers created a problem where one in every ten Medicare Part D beneficiary spent into the reinsurance region, thereby limiting their ability to avoid highest-cost medications.

Research Strategy:

To identify common problems and challenges with the Medicare Part D program from consumers and providers, we started by examined studies by trusted directories such as the US Department of Health, CDC, the US National Library of Medicine, and others. Also, we investigated the portals of significant Medicare Part D providers, including Anthem Blue Cross, Wellmark, and others in search of reports, news articles, and blogs revealing challenges they and their enrollees faced. This research produced studies and reports by NCBI, the US Department of Health, Boomer Benefits, ProPublica, and others with insights into the most prominent problems with Medicare Part D for consumers and providers.

Then, we proceeded to research media and medical domains such as the NY Times, Medicare Rights, the KFF Organization, and others to identify problems and challenges with Medicare Part D, most prominently discussed in news articles and medical blogs. This research showed that the same issues and challenges identified by the authoritative directories we examined earlier were the same ones reported and referenced. Hence, we grouped the most common problems and challenges identified by all the directories we researched having information relevant to this request in the public domain.


Sources
Sources

From Part 03
Quotes
  • "One in three Medicare Part D beneficiaries received a prescription opioid in 2016 "
  • "About 500,000 beneficiaries received high amounts of opioids "
  • "Almost 90,000 beneficiaries are at serious risk; some received extreme amounts of opioids, while others appeared to be doctor shopping "
  • "About 400 prescribers had questionable opioid prescribing patterns for beneficiaries at serious risk"
Quotes
  • "The IG found that heavy painkiller use and abuse remains a serious problem in Medicare’s prescription drug program, known as Part D, which serves more than 43 million seniors and disabled people."
  • "Officials have known for years that opioid prescribing has been a problem in Medicare. ProPublica first highlighted the problem in 2013 when we published data on the drugs prescribed by every physician in the Part D program."
Quotes
  • "When enrollees’ drug costs are relatively low, plans pay a large share, typically about 75 percent. But when enrollees’ drug spending surpasses a certain catastrophic threshold — set at $5,000 in out-of-pocket spending in 2018 — 80 percent of drug costs shifts to a government program called reinsurance. "
  • "Reinsurance spending, which is not reflected in premiums, has been rising rapidly. “This harms the very competition that Part D was supposed to establish,” said Roger Feldman, an economist at the University of Minnesota."
  • "The Medicare Payment Advisory Commission has been warning about this problem for several years in its annual reports to Congress. According to MedPAC, between 2010 and 2015, the number of enrollees entering the catastrophic drug cost range grew 50 percent, from 2.4 million to 3.6 million, now accounting for 8 percent of enrollees."
Quotes
  • "While low cost was essential to many, other characteristics like having the same plan as a partner, company reputation, convenience, and anticipation of possible future health problems were sometimes more important. Although some used resources including insurance brokers, counselors, and websites beyond Medicare.gov, many expressed a desire for greater assistance with and greater simplicity in the choice process."
  • "You have to almost have an accountant.” Additionally, a participant said, “I mean I think I have more problems with the health care thing than I do with the income tax, which is not easy.”"
Quotes
  • "Worst of all, resolving common problems with these plans is time-intensive. Here at Boomer Benefits, Part D issues are responsible for about 70% of my Client Service Team’s time spent on the phones. We are ALWAYS helping our clients resolve issues with Part D."
Quotes
  • "The existing Part D cost-sharing structure creates a substantial financial burden for specialty drug users, especially early in the year. Implementing both annual and monthly OOP maximum spending limits would result in lower, more consistent OOP costs, potentially increasing patients’ ability to access treatments for life-threatening, chronic, and rare diseases."
Quotes
  • "Medicare Part D has helped to make prescription drugs more affordable for people with Medicare, yet many beneficiaries continue to face high out-of-pocket costs for their medications. Specialty tier drugs—defined by Medicare as drugs that cost more than $670 per month in 2019—are a particular concern for Part D enrollees in this context."
Quotes
  • "Conversely, standalone Part D plan sponsors contract with pharmacies to make the medi­cations available directly to beneficiaries."
  • "Physicians who prescribe Part D drugs for administration in their offices face numerous barriers in financing and adminis­tering care."
  • "The Government Account­ability Office found that 80% of physicians said the time needed to identify beneficiary coverage and submit claims posed a hurdle to administering Part D vaccines."