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 http://www.jdpower.com/resource/us-medicare-advantage-study.

Employer Sponsored Insurance Rate Remains Stable

Since 2009, employer-sponsored insurance has been on the decline in California. A key question around the Affordable Care Act (ACA) was whether the reforms would further erode employer-sponsored insurance coverage. A recent survey by the California HealthCare Foundation finds that employer-sponsored insurance in the state has remained stable from 2013 to 2015. Worker eligibility for employer-sponsored insurance also remained stable, and even increased among some groups. However, the percentage of eligible workers who chose to enroll in employer-sponsored insurance declined from 86.4% in 2013 to 80.2% in 2015, bringing California closer to the national average take-up rate of 79%. This decline could be caused by the availability of alternative coverage options through Medi-Cal and Covered California.

Dental Coverage Legislation

Senators Pat Roberts (R-KS) and Michael Bennet (D-CO) introduced bipartisan legislation to clarify that people outside the public exchanges can have the same choices for dental coverage as people inside the public exchanges. The Aligning Children’s Dental Coverage Act (S. 3244) is a companion to HR 3463, sponsored by Representatives Morgan Griffith (R-VA) and Diana DeGette (D-CO).

Inside the exchanges, parents can pick stand-alone dental benefits for their children as an option. About 99% of Americans select dental coverage separately from their medical coverage. But, outside the public exchanges, the Affordable Care Act isn’t clear on whether families can purchase stand-alone dental plans as part of the required pediatric dental care benefit. As a result, individuals, employers, and carriers are confused about what coverage options are available.

Jason Daughn, vice president of government relations for Delta Dental Plans Assn. said, “The Senate and House legislation offers a simple, but crucial solution to ensure that families across the nation continue to have the access they need and the choices they deserve in obtaining dental benefits. This is a common sense solution to an issue that could pose big problems to families and children across the nation.”

Employment-Based Health Coverage Holds Steady

Sixty-two percent of the non-elderly population had employment-based health overage in 2014, which is the same as in 2013, according to the Census Bureau. The percentage of non-elderly people in the United States with health insurance increased from 2013 (84.6%) to 2014 (88%). The percentage of uninsured when down from 2013 (15.4%) to 2014 (12%). Just over 32 million were uninsured in 2014, down from 41.1 million in 2013. The increase in health coverage among the entire non-elderly population came from growth among people buying health insurance directly from an insurance carrier (up from 8.8% in 2013 to 12.6% in 2014) and from enrollment in public programs (up from 19.3% in 2013 to 21.7% in 2014).

The Cost Implications of Private Exchanges

Private exchanges could encourage employees to select less-generous plans, according to a report by Rand. This could expose employees to higher out-of-pocket costs, but premium contributions would drop substantially, so net spending would decrease. On the other hand, employee spending may increase if employers decrease their health insurance contributions when moving to private exchanges. Most employers can avoid the ACA’s Cadillac tax by reducing the generosity of their plans, regardless of whether they move to a private exchange. There is not  enough evidence yet to determine whether private exchanges will become prominent and how they will affect employers and their employees.

Workers who choose less-generous plans could risk higher out-of-pocket costs. But their net spending would drop because premiums would drop substantially. Average employee spending could increase if employers lower their health insurance contributions when moving to private exchanges. Private exchanges are unlikely to significantly affect the ACA’s Small Business Health Options Program (SHOP) Marketplaces.

Exchange Consumers Are Becoming Savvy Shoppers

People who get health insurance through the public health insurance exchanges are increasingly confident about their ability to afford coverage. Also, they are just as satisfied with their coverage as are people with employer coverage, according to a Deloitte Consulting survey. Seventy percent of exchange consumers were able to manage their out-of-pocket expenses in the past year and only 25% had higher out-of-pocket costs than expected. However, lower-income people had a hard time paying for out-of-pocket costs.

Greg Scott of Deloitte said, “Health care consumers’ expectations for information and transparency are increasing, as is their interest in intuitive tools to access relevant information. Meeting these expectations should lead to increasingly more confident and satisfied customers.” Paul Lambdin of Deloitte said, “Out-of-pocket costs… are making exchange consumers pay close attention to the details of their coverage and changes in benefits and premiums.”

Knowing what costs to expect could also be increasing confidence. More exchange consumers understand the costs of their coverage than do people with employer insurance. Sixty-one percent of exchange consumers look at the total costs – not just premiums – when evaluating coverage options.

Also, more exchange customers are willing to accept network tradeoffs for lower payments than in 2015. These tradeoffs include a smaller network of hospitals (27% in 2016 as compared to 18% in 2015), a network that does not include their primary-care provider (26% in 2016 as compared to 16% in 2015), and a smaller network of doctors (26% as compared to 18% in 2015).

Sixty-six percent of exchange consumers used online tools to compare out-of-pocket costs compared to 58% of consumers with employer coverage. Scott said, “Exchange consumers continue to shop around for coverage and evaluate costs before making decisions and appear to be responding to messages about going online to look for health insurance information.”

Californians Are Encouraged To Explore Mental Health Coverage

The California Assn. of Marriage and Family Therapists (CAMFT) urges Californians to investigate mental health coverage during open enrollment. Under California law, psychotherapy may be much more affordable than most people assume. The Affordable Care Act and the Mental Health Parity and Addiction Equity Act require insurers to provide behavioral health coverage to treat mental health disorders or substance abuse  that is comparable to coverage for treatment of physical health with no annual limits. Despite robust access to affordable mental health care, many policyholders are not utilizing it to their full benefit. Often, the obstacle is a lack of information about the available options. The website, CounselingCalifornia.com, allows consumers to search for local therapists who accept clients with managed care plans.

Coverage Makes a Difference When It Comes to Surviving Cancer

Coverage Makes a Difference When It Comes to Surviving Cancer


Medi-Cal patients with breast, colon, and rectal cancer are more likely to be diagnosed at an advanced stage of disease and have lower five-year survival rates compared to those with other sources of health insurance, according to a survey by the UC Davis Health System. Medicare-Medi-Cal dual eligible patients are the least likely to get recommended treatment for breast and colon cancer.

VA patients have the longest intervals between diagnosis and treatment for breast, colon, rectal, lung, and prostate cancers, but their treatment outcomes compare favorably to patients with other types of health insurance, and they are generally more likely to get recommended treatment.

Researchers were not surprised that Medi-Cal and Medicare-Medi-Cal dual eligible, and uninsured patients were getting diagnosed at a later stage of cancer and had lower survival rates since adverse social factors affect these populations. But the lower quality of care cannot be as readily explained. In light of the rapid growth of Medi-Cal, the findings highlight the need to investigate the disparities in cancer care, according to the study

Federal Action Could Expand Private Retirement Coverage

About half of private sector workers in the United States have no access to a workplace retirement savings program, especially those who are low-income or employed by a small firm, according to a report by the General Accountability Office (GAO). This is an important issue for states because millions of workers who don’t have enough retirement savings could strain safety net programs.

About 45% of private sector workers participate in a workplace retirement savings program. Using tax data to correct for under-reporting raised the share of workers participating to 54%, but it still indicates that many workers lack coverage. Eighty-four percent of those who are not participating work for employers that don’t offer retirement savings programs or they are not eligible for the programs because they are new employees or in jobs that are excluded from participating. The majority of lower-income workers and those employed by smaller firms say they would participate in a workplace retirement program if is was offered.

Key strategies to expand private sector coverage include encouraging or requiring workplace access, having automatic enrollment, offering financial incentives, and simplifying the program. Pending implementation, California and Illinois would require certain employers to enroll workers automatically in a state-run program, though workers could choose to opt-out.

Combining workplace access with automatic enrollment and financial incentives has helped increase participation in the countries that GAO studied. States and countries have tried to simplify programs by reducing complexity, cost, and risk for workers. Some states intend to reduce burdens for employers by selecting and monitoring providers. They plan to reduce the complexity for workers by limiting investment options.

State and national stakeholders say that the Employee Retirement Income Security Act of 1974 (ERISA) creates challenges that could delay or deter state efforts to expand coverage. ERISA preempts any state law relating to employee benefit plans for private sector workers. Four of the six states that GAO reviewed intend to create payroll deduction IRA programs that would not be considered employee benefit plans. But under ERISA, it is unclear whether a state can offer such programs or certain program features. Regulations from the Departments of Labor (DOL) and the Treasury also create uncertainty.

In addition to federal efforts, a growing number of states have proposed efforts to expand coverage in private sector workplace retirement savings programs. Other countries have also implemented similar efforts. GAO suggests that Congress consider giving states limited flexibility to expand private sector coverage. Agencies generally agreed with GAO’s recommendation. DOL plans to issue a proposed rule on state programs by the end of 2015

Medicare Advantage and Part D Market to Remain Stable in 2016

The market for Medicare Advantage and Medicare prescription drug plans will remain stable in 2016, according to the Medicare Rights Center. Next year, consumers will continue to see a stable Part D plan market with average premiums at $32.50 per month. The coverage of generic drugs increases to 42% of the cost of the drug in the doughnut hole. Coverage of brand name drugs will remain at 55%. Millions of older adults and people with disabilities will see affordable premiums and similar access to plans as they have in years past. As the Affordable Care Act (ACA) strengthens Medicare Advantage and prescription drug plans, beneficiaries are protected from significant increases in plan costs, benefits remain stable, and access to higher-quality plans is strong.

Enrollment in Medicare Advantage is at an all-time high. Next year the average premium will be $32.60, down from $32.91 in 2015. Additionally, 99% of people with Medicare will have access to a plan in 2016. There are now more four to five star plans than ever based on Medicare’s Star Quality Rating.

Last Updated 09/12/2019

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