How Medicare Advantage Plans Can Increase Consumer Satisfaction

Medicare Advantage plans are more likely to achieve high satisfaction scores when they offer a consistent product message and brand experience and have control over the delivery of care, according to a J.D. Power study. Members frequently choose a plan they understand and find easy to work with. The study measures member satisfaction with Medicare Advantage plans based on six factors in order of importance: coverage and benefits (26%); customer service (20%); provider choice (15%); cost (14%); information and communication (13%); and claims processing (13%).

Improving communications with enrollees is one of the greatest opportunities for health plans to improve member satisfaction. It’s the only factor in the study that has not seen a significant improvement in member satisfaction. Valerie Monet, director of the insurance practice at J.D. Power, said that many plans have multiple product design features and come with technical manuals that are 20 pages or longer. Expecting members to be experts on these services and benefits is a losing battle for the plan and the member. Members expect their plan to provide guidance, ranging from assistance in selecting a doctor to helping them understand prescription costs.

Forty-eight percent of members agree strongly that their health plan is a trusted partner in their health and wellness, which increases satisfaction by 166 points. Satisfaction is 136 points higher among the 89% of members who completely understand how to find a doctor under the plan. Satisfaction is 110 points higher among the 88% of members who say their doctor spends the right amount of time with them.

Members expect immediate attention or advice when they call their health plan provider. Forty-one percent of those who called their plan had to give the same information more than once to get their issue resolved. Only 35% of members said that customer service provided all of the information they needed on the costs of prescription medications. Ninety-one percent of customers who are delighted with their Medicare Advantage plan (satisfaction scores of 901 or higher), say they will definitely renew their policy, and 89% will definitely recommend their plan to family and friends. Loyalty drops to 71% and advocacy to 66% among members who are pleased with their plan (scores of 751-900). Plans garnered the following member-satisfaction scores:

  • Kaiser Permanente 851
  • Highmark 791
  • Humana 782
  • UnitedHealthcare 775
  • Cigna 774
  • Aetna 773
  • Anthem 765
  • Health Net 756
  • WellCare 742

In 2016, members reported an average increase of $117 in annual premiums to $1,497. They also have more out-of-pocket expenses. On average, member deductibles are $1,705 in 2016, a $310 jump from 2015. Satisfaction is 136 points higher when members completely understand their out-of-pocket costs. Monet said that members are more satisfied and see the value of their plan when they have a better understanding of how much they are paying and what the costs cover.” For more information visit

Study: Premiums drive consumer selections in ACA marketplaces

Consumers purchasing coverage from Affordable Care Act health insurance marketplaces are gravitating toward the cheapest plans, and healthy consumers in particular are shopping for the lowest prices, while those selecting higher-cost plans that tend to allow more provider choice have been sicker than anticipated. A federal analysis shows two-thirds of American consumers bought the lowest- or second-lowest-cost coverage in each tier in 2014, and about 50% purchased the cheapest plans last year.

The New York Times (free-article access for SmartBrief readers) (8/12)

Consumer Choices in the Affordable Care Act Marketplace

Under the ACA marketplaces, consumers in most regions of the country have multiple options from which to select a health plan, according to a study by the Blue Cross Blue Shield Assn. (BCBSA). However, the types of health plans are changing to meet the needs of customers and to manage risk for health insurers. For example, the share of HMO and exclusive provider organization (EPO) products increased from 41% in 2015 to 52% in 2016. HMO products were the lowest cost Silver Plans in 57% of counties in 2016 compared to 46% in 2015.

Price differentials are narrowing. In 2014, more than 29% of counties had the lowest cost Silver Plans. These plans cost more than 10% less than the next lowest competitor’s option. In 2015, that number dropped to less than 5%. In 2016, only 1% of counties had this large of a price differential between the two most affordable Silver Plans.

Maureen Sullivan of BCBSA said, “Insurance carriers are applying more data including the actual health care costs of newly enrolled members to design offerings that more accurately meet the needs of consumers in this new market.”

Seniors Gain Greater Consumer LTCI Protections

Governor Brown signed Senate Bill 575 into law. It requires long-term care insurers to provide annual notifications of the availability of non-forfeiture benefits and contingent benefits to the insured and the insured’s designated backup contact. The bill was authored by Senator Carol Liu and sponsored by Insurance Commissioner Dave Jones. “Without notification, individuals and their families can easily lose track of…benefits and may end up paying for care or missing out on benefits that are available to them,” Jones said. Consumers may stop making premium payments because they can no longer afford them. Although the long-term care benefits may still be available to the consumer even after they stop making payments, the benefits may not be utilized by the consumer until years after the policy has lapsed, which is why consumers may forget the benefits are available.

Survey: Consumer-directed health plans encourage cost-conscious behavior

People enrolled in health plans with high deductibles and linked to a health savings or reimbursement account are more likely than those in traditional plans to check their benefits, request a generic drug in place of a brand-name drug, and check the price before getting care, according to a survey by the Employee Benefit Research Institute and Greenwald & Associates. Enrollees in consumer-directed plans were also more likely than those in traditional plans to discuss treatment options with their health care providers, the survey found. (12/20)

ACA Will Test Consumers’ Loyalty to Their Doctors

Half of consumers would switch their doctor if they could save a certain amount in annual health care costs, according to a survey by HealthPocket. Thirty-four percent would switch if they could save $500 to $1,000; eight percent would switch if they could save $1,000 to $2,000; and 8% would switch if they could save $3,000 or more.

Consumers and small employers will face an array of new health plan choices in 2014. Other than cost, one of the key factors in consumers’ selection process is whether their doctor participates in a plan’s provider network. Cost pressures are moving insurers to limit their provider networks. They are seeking to negotiate lower rates to healthcare providers in exchange for a larger volume of patients.

HealthPocket is offering a physician search component on its site at It allows consumers to compare all commercial health plans, Medicare plans and Medicaid programs that their doctor may accept.

Last Updated 10/20/2021

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