Nearly 7 in 10 Medicare Beneficiaries Did Not Compare Plans During Medicare’s Open Enrollment Period

Each year, Medicare beneficiaries can explore their coverage options and change plans during the annual Open Enrollment period (October 15-December 7). Medicare beneficiaries with traditional Medicare can compare and switch Medicare Part D standalone drug plans or enroll in a Medicare Advantage plan, while Medicare Advantage enrollees can compare and switch Medicare Advantage plans or choose traditional Medicare coverage with or without a standalone drug plan. Beneficiaries have no shortage of plans to choose from. In 2024, the average Medicare beneficiary will have 43 Medicare Advantage plans and 21 Part D standalone prescription drug plans (PDPs) to choose from.

The Medicare private plan market operates on the premise that Medicare enrollees will compare plans during the open enrollment period and choose the best source of insurance given their individual needs and circumstances. Coverage and costs for both Medicare Advantage plans and Part D prescription drug plans vary widely and can change from year to year. This can lead to unexpected and avoidable costs and interruptions in care for beneficiaries who do not review their options annually. For example, changes in Medicare Advantage provider networks can result in beneficiaries losing access to their preferred physicians. In addition, changes to the list of covered drugs and cost-sharing requirements can increase out-of-pocket drug costs. In addition, beneficiaries’ health care needs can change from year to year. Even if no changes are made to the plan and no changes are made to their health, beneficiaries may find a plan that better suits their individual needs or has lower out-of-pocket costs.

In focus groups conducted by KFF, Medicare beneficiaries highlighted many of the factors important to them in choosing Medicare coverage, such as out-of-pocket costs, access to certain doctors and prescription drug coverage. But Medicare beneficiaries also said they have difficulty understanding and comparing different plan options and are overwhelmed by the barrage of television advertising, most of which is for Medicare Advantage plans.

In this analysis, KFF draws on an analysis of the 2022 Survey of Current Medicare Beneficiaries (the most recent year available) to examine the share of Medicare beneficiaries who used official Medicare information resources to review their 2022 coverage and compare plans during the 2021 open enrollment period, as well as differences by demographic group.

Key Takeaways

• Overall, about seven in seven Medicare beneficiaries (69%) did not compare their Medicare source of coverage to other Medicare options offered in their area during the 2021 open enrollment period, while 31% did. More traditional Medicare beneficiaries than Medicare Advantage beneficiaries did not compare their source of coverage to other plans (73% vs. 65%).
• More than four in 10 Medicare Advantage enrollees (43%) did not review their current plan coverage to see if there were any potential changes to their plan premiums or other out-of-pocket costs, while the rest (57%) did. A similar share (44%) did not review their current plan to see if there were any potential changes to the types of treatments, drugs, or services they would be covered for the next year.
• The majority of Medicare Advantage prescription drug plan (82%) and stand-alone prescription drug plan (PDP) (69%) enrollees did not compare their plan’s drug coverage to the drug coverage offered by other plans in their area.
• Official Medicare information resources are used by fewer than half of Medicare recipients, with only a quarter (26%) calling the toll-free number, four in ten (42%) visiting the Medicare website, and just over half (54%) reading any part of it. Medicare and You

Nearly 7 in 10 Medicare beneficiaries did not compare Medicare coverage options during the 2022 open enrollment period.

Overall, the majority of Medicare beneficiaries (69%) reported that they did not compare their current Medicare plan to other Medicare insurance options that were available during the 2021 open enrollment period for 2022 insurance enrollment. (Figure 1, Table 1Among Medicare Advantage enrollees, nearly two-thirds (65%) did not compare their 2022 coverage options, even though annual changes to Medicare Advantage plans, such as changes to provider networks or prior authorization requirements, can affect enrollees’ access to care.

The proportion of Medicare beneficiaries who did not compare Medicare coverage was higher for certain subgroups, including beneficiaries with lower income and education, Hispanic beneficiaries, those with dual Medicare and Medicaid coverage, those under age 65 with disabilities, those over age 85, and beneficiaries with cognitive impairments (Figure 2, Appendix Table 1).

More than four in 10 Medicare Advantage enrollees have not reviewed their plans for potential changes to covered costs or services in the coming year.

For Medicare Advantage enrollees, premiums, cost sharing, and out-of-pocket limits can vary from year to year and from plan to plan. Medicare Advantage plans have flexibility to change cost sharing for most services, with limitations. Medicare Advantage plans may offer additional (“supplemental”) benefits not covered under traditional Medicare, but the type and scope of specific services often varies from year to year. In addition, nearly all Medicare Advantage enrollees are in plans that impose prior authorization requirements for certain services, and these plans, subject to federal standards, can change the list of covered drugs and expand or shrink their networks of physicians and other health care providers from year to year.

More than four in ten (43%) of Medicare Advantage enrollees did not review their current plans during the open enrollment period to see if there were any changes to their monthly premiums, deductibles, co-payments or other out-of-pocket costs for 2022, while the remaining 57% reported that they did (Figure 3, Appendix Table 2Similarly, 44% of Medicare Advantage enrollees did not review their current plans for changes in the types of treatments, drugs or services their coverage will provide in 2022.

The proportion of Medicare Advantage enrollees who have not reviewed their plans for changes in costs or services was higher among certain enrollees, including those with lower incomes and education levels, black and Hispanic enrollees, those who self-reported fair or poor health, enrollees aged 85 or older, and those eligible for dual coverage through Medicare and Medicaid (Figure 3, Appendix Table 2).

For example, half of Medicare Advantage enrollees who reported being in fair or poor health did not check whether there were any changes to their monthly premiums, deductibles, or co-payments, or to the types of treatments, drugs, or services they covered. Nearly two-thirds (65%) of Hispanic Medicare Advantage enrollees and half (50%) of Black enrollees did not review their plans for changes in costs, as did changes in services (64% and 48%, respectively). Additionally, nearly 60% of adults aged 85 and older did not review their plans for changes in costs (57%) or services (58%).

Most Medicare beneficiaries with Part D prescription drug insurance did not compare their plan’s drug coverage with other drug coverage options.

Part D plan costs (including premiums, deductibles and cost-sharing requirements) can change from year to year and vary from plan to plan. Additionally, Part D plans may make changes to your formulary, such as adding or removing medications from coverage or adding or changing utilization management requirements that apply to certain medications, such as prior authorization or step therapy.

The prescription drug provisions of the Control Inflation Act include changes that will lower out-of-pocket costs for all Part D enrollees, including a new $2,000 cap on out-of-pocket costs beginning in 2025. In response to these changes, Part D plan sponsors may make changes to plan premiums, prescription drugs and cost sharing, making it especially important for beneficiaries to compare prescription drug options during open enrollment.

Nearly eight in 10 (82%) enrolled in Medicare Advantage plans with prescription drug coverage (MA-PD) did not compare the drug coverage offered by their MA-PD with that of other MA-PDs in their area during the 2021 open enrollment period (Figure 4; Appendix Table 3). A low percentage of stand-alone prescription drug plan (PDP) participants, 69%, said they have not compared the drug coverage offered by their current PDP with other PDPs.

The proportion of beneficiaries with MA-PD or PDP coverage who did not compare drug coverage offered by their insurance coverage in 2022 was higher among women, beneficiaries with lower income and education levels, Hispanic beneficiaries, beneficiaries aged 85 years or older, and dual eligibles (appendix Table 3).

Fewer than half of beneficiaries use Medicare information resources

Medicare provides information resources to help beneficiaries understand their Medicare benefits, coverage options, and costs, including through 1-800 Medicare toll-free, the Medicare.gov website, Medicare and You A handbook is distributed annually to all Medicare beneficiaries. However, these resources are not widely used, especially by calling the toll-free number (Figure 5, Appendix Table 4).

• About one-quarter (26%) of Medicare beneficiaries reported calling the 1-800-MEDICARE helpline to get information, while the remaining three-quarters (74%) of Medicare beneficiaries reported either never calling the helpline to get information (51%) or were unaware of the existence of the helpline (23%).
• Four in ten Medicare beneficiaries (42%) said they (or someone acting on their behalf) have visited the official Medicare website for information, but more than half (58%) said they have never visited the website (36%) or do not have access to the internet or no one to do so for them (22%).
• More than half (54%) of Medicare recipients Medicare and You Forty-six percent of respondents indicated they had read the handbook (either in full or in part), while 46% indicated they had not read the handbook (31%), had not received the handbook, or were unsure if they had received it (15%).

The percentage of Medicare beneficiaries who used Medicare information sources was lower for certain subgroups, including black beneficiaries, individuals aged 75 to 84, and dually eligible individuals (Appendix Table 4).