What Do People with Medicare Think About the Role of Marketing, Shopping for Medicare Options, and Their Coverage?

Executive Summary

Medicare is the federal health insurance program that covers over 65 million adults 65 and older and younger adults with long-term disabilities. Medicare is a very popular program, with 81% of the public holding favorable views of the program, and is viewed positively by large majorities of Democrats, Republicans, and Independents.

Over the past 15 years, the role of private plans in Medicare has increased dramatically. Today, more than half of all Medicare beneficiaries are enrolled in a Medicare Advantage plan, with an average of 43 plans to choose from in addition to traditional Medicare. Beneficiaries in traditional Medicare can choose among 24 stand-alone Part D plans, on average, and may choose supplemental coverage, such as Medigap, if they don’t have supplemental coverage under Medicaid or an employer or union-sponsored retiree health plan. This increasingly crowded marketplace has been accompanied by extensive marketing and advertising as well as agents and brokers competing to attract enrollees.

To capture Medicare beneficiaries’ views and experiences in choosing between traditional Medicare and private plans, and among private plans, and the factors that influence these decisions, KFF worked with PerryUndem to conduct focus groups with Medicare beneficiaries in the Fall of 2022, during the annual Medicare open enrollment period. This report summarizes first-hand accounts of participants’ reactions to phone calls, TV advertisements and other marketing activities they encounter during the open enrollment period, what influences their decision-making, including the role of licensed agents (also known as brokers), how much Medicare beneficiaries understand about their Medicare choices, what they think of the Medicare marketplace, and how well their Medicare coverage is working for them.

The focus group participants included Medicare beneficiaries ages 65 and older and younger adults with disabilities who make health coverage decisions for themselves and/or their spouse or family member. Some focus groups also consisted of people with both Medicare and Medicaid (also referred to as dual-eligible individuals or dual eligibles) as well as adults 64 years old who were approaching Medicare enrollment. Because the study focused on decisions pertaining to Medicare coverage, including Medicare Advantage and traditional Medicare supplemented by Medigap, we excluded people on Medicare with retiree coverage from a former employer or union.

Key Takeaways

• Many participants reported experiencing aggressive marketing tactics pushing Medicare plans, including unsolicited phone calls. Many participants reported getting frequent phone calls from brokers or plan representatives advertising Medicare plans, though it was not always clear to participants who was calling.
• Nearly all participants have seen TV advertisements that are marketing Medicare, most frequently Medicare Advantage plans. Participants reported they were often confused about who was sponsoring the ads. Some participants emphasized that who was sponsoring the ads was often unclear, noting many of the ads had the appearance of being sponsored by the government though they believed the ads were in fact sponsored by private companies.
• Participants did not trust the content of the ads, particularly the ones that marketed a slew of “free” benefits. In general, many thought TV advertisements were misleading. Celebrities are often spokespeople for these advertisements, though participants did not seem to be swayed by them. Overall, participants said that Medicare private plan marketing and advertising did not play a role in their plan choices.
• Most participants found the process of selecting their coverage to be confusing, difficult and overwhelming. As a result, many participants relied on a broker to assist them when choosing their coverage and valued their expertise. Participants who use brokers to help select and enroll in a Medicare plan say brokers are a trusted resource. Most of the participants who used brokers did not seem bothered by potential financial incentives to enroll them in a certain plan.
• Few participants used government resources when making coverage decisions, such as the Medicare Handbook or 1-800 Medicare, but those participants who did use these government resources generally found them helpful. Most participants had not heard of or used State Health Insurance Assistance Programs (SHIPs), which provide local and objective insurance counseling to people on Medicare.
• Focus group participants highlighted a number of factors that were important in choosing their coverage when they first enrolled in Medicare, including premiums and out-of-pocket costs, access to specific doctors, availability of extra benefits, and coverage of prescription drugs. Some participants who are enrolled in Medicare Advantage plans also said they enrolled in a particular plan because its name was familiar or because the company had a good reputation. Participants generally did not take into account Medicare’s star quality ratings of plans to inform their plan choices, though some did their own research on a plan’s quality using non-government resources.
• Most focus group participants – whether in traditional Medicare or Medicare Advantage – said they were relieved to get on Medicare and are satisfied with their coverage. However, some participants cited specific issues with their coverage that varied based on their source of Medicare coverage.
  • Participants with traditional Medicare and a supplemental Medigap policy are generally pleased with their coverage, including low or no cost-sharing for Medicare services, protection against catastrophic expenses, broad access to providers since virtually all physicians take Medicare and Medigap, and feeling that have control over their health care, but some expressed concern about the cost of Medigap premiums.
  • Participants in Medicare Advantage are also generally satisfied with their coverage because of the zero or low premiums, and extra benefits offered by their plan, such as dental, vision, and hearing services, but some encountered high medical bills when using certain services, faced delays in care, such as having to wait weeks to see specific physicians due to prior authorization and referrals, and had issues in accessing preferred doctors due to network restrictions.
  • Dual-eligible participants – whether they had Medicare coverage through traditional Medicare or a Medicare Advantage plan – also reported being generally satisfied with their coverage, particularly due to the low out-of-pocket costs for their health care, such as no copays for doctor’s visits. However, some-dual eligible participants with Medicare Advantage had issues finding providers, such as primary care doctors, who would take both their Medicare and Medicaid coverage.
  • Participants enrolled in Medicare Advantage, including some dual-eligible individuals, also noted difficulty using some of their supplemental benefits, particularly dental benefits, due to network restrictions and certain providers not taking their coverage.
  • Participants in Medicare Advantage and Medicare Part D stand-alone drug plans reported being frustrated at the high out-of-pocket costs of some of their prescriptions.
• The majority of participants do not review their coverage options every year, and even fewer switched plans because they felt they would not be better off with a different option. Participants generally feel they made the right choice – whether in traditional Medicare or Medicare Advantage – when selecting their coverage and feel it is working well enough for them. Therefore, participants do not see the need to look again at their coverage options; however, many wish they had had more information before enrolling.
• Some participants with both Medicare and Medicaid were concerned about losing their Medicaid coverage, and were anxious about losing Medicaid during the redetermination process as states resume disenrollments after a three year pause during the pandemic.