Medicare Advantage Plans have become an increasingly popular alternative to Original or traditional Medicare. Nearly half of all Medicare beneficiaries are now enrolled in Medicare Advantage Plans. But are enrollees actually satisfied with their Medicare Advantage coverage?
In this comprehensive guide, we’ll explore what research shows about satisfaction rates for Medicare Advantage Plans. We’ll look at the pros and cons of Medicare Advantage and what factors may influence someone’s happiness with their plan.
Medicare Advantage Beneficiary Satisfaction Rates
According to most studies, a majority of Medicare Advantage enrollees report being satisfied with their coverage. For example:
- A 2021 survey by the Kaiser Family Foundation found 87% of Medicare Advantage enrollees were “very or somewhat satisfied” with their plan.
- A report by the Medicare Payment Advisory Commission (MedPAC) found 79% of Medicare Advantage enrollees gave their plan a rating of 8, 9 or 10 on a scale of 0-10.
- J.D. Power’s 2019 Medicare Advantage Satisfaction Study found the average satisfaction score among MA-PD plan members was 790 out of 1000, which they classified as “among the highest in the insurance industry.”
So in general, it appears most people enrolled in Medicare Advantage are happy with their coverage. But satisfaction can vary significantly between different Medicare Advantage Plans. And there are both advantages and disadvantages to Medicare Advantage that impact enrollee satisfaction.
Pros of Medicare Advantage Plans
There are many reasons why Medicare Advantage appeals to beneficiaries and receives high satisfaction scores:
Many Medicare Advantage Plans include dental, vision and hearing coverage. They may offer gym memberships, transportation services or over-the-counter benefits not covered by Original Medicare.
Unlike Original Medicare, Medicare Advantage Plans cap your annual out-of-pocket spending for covered medical services. This provides financial protection and peace of mind.
Medicare Advantage Plans combine all your health insurance coverage in one plan. There’s no need for a separate Part D prescription drug coverage or Medigap policy.
Medicare Advantage Plans usually require you to get care within their network. This can promote more coordinated care between providers.
Some Medicare Advantage Plans have $0 monthly premiums beyond the Medicare Part B premium. This provides savings compared to Medigap Plans.
For these reasons, many Medicare beneficiaries are drawn to Medicare Advantage and are happy with the coverage and health services they receive.
Cons of Medicare Advantage
However, there are also some potential drawbacks of Medicare Advantage that can impact satisfaction:
Plans may not include a beneficiary’s preferred doctors and hospitals, which requires them to change providers.
Seeing specialists often requires referrals and prior authorizations, which can delay care.
Those living in rural areas may need to drive long distances to see in-network providers.
Part D Plan formularies may not cover all medications a beneficiary needs.
Some studies suggest health outcomes may be worse in Medicare Advantage vs. Original Medicare.
Lack of Medigap Coverage
Beneficiaries lose the ability to enroll in Medigap Plans for supplemental coverage.
These disadvantages of Medicare Advantage can lead some enrollees to feel less satisfied with their coverage.
Factors Influencing Satisfaction
Research has shown Medicare Advantage satisfaction can vary significantly based on:
Health Status – Those in poorer health are often less satisfied, due to higher utilization and encountering plan restrictions.
Plan Type – Satisfaction is lower among HMOs than PPOs due to network flexibility.
Premiums – Enrollees are less satisfied when plans increase premiums year-over-year.
Cost Exposure – Satisfaction drops if out-of-pocket costs are higher than expected.
Customer Service – Poor experiences dealing with the insurance plan can reduce satisfaction.
So even among Medicare Advantage enrollees, satisfaction rates can vary greatly depending on the specific plan and individual factors.
Choosing the Right Medicare Advantage Coverage
If you’re considering Medicare Advantage, choose carefully to maximize satisfaction. Here are some tips:
- Check that your providers are in-network and the plan includes your medications.
- Understand the plan’s referrals rules and out-of-pocket costs.
- Consider both premiums and benefits when comparing plans.
- Select an HMO for low costs or PPO for network flexibility.
- Use the Medicare Plan Finder to compare plan ratings.
- Call insurers to learn more about their customer service.
- Confirm the plan has high member satisfaction scores.
Taking time to research and enroll in the right Medicare Advantage Plan for your needs is key to being happy with your coverage.
Weighing Medicare Advantage vs. Medigap
One important consideration is whether Medicare Advantage or Medigap coverage would be a better fit for you.
Medigap Plans allow you to keep your providers under Original Medicare. But they have higher premiums and no added benefits beyond supplemental coverage.
Medicare Advantage Plans offer benefits like dental and vision but restrict your provider network.
There are pros and cons to each approach. Make sure to understand both options thoroughly so you select the best coverage.
Can You Change Plans If You’re Not Satisfied With Their Coverage?
If you enroll in a Medicare Advantage Plan but find you are unhappy with it, in most cases you can switch back to original Medicare during Medicare Open Enrollment from October 15 to December 7 each year.
You can also switch Medicare Advantage Plans or go back to original Medicare during the Medicare Advantage Open Enrollment Period from January 1 to March 31.
So you do have options if you find a Medicare Advantage Plan is not a good fit for you, which can provide some peace of mind.
The Bottom Line
Research shows a majority of Medicare Advantage enrollees are satisfied with their coverage. But satisfaction rates vary significantly based on the individual plan and personal factors.
By understanding the pros and cons of Medicare Advantage and choosing a plan wisely, you’re more likely to be satisfied with this alternative to Original Medicare. But you also have options to change plans if needed.
Weighing all these factors carefully will help ensure you select Medicare Advantage coverage or Original Medicare with Medigap that best fits your needs and provides the highest satisfaction.
We’re Here to Help
You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at American Entitlements a Call at (469) 814-0289. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.
- What is the difference between traditional Medicare and Medicare Advantage?
Traditional Medicare (also called original Medicare or fee-for-service Medicare) is operated by the federal government, while Medicare Advantage is an alternative to traditional Medicare run by private insurance companies approved under traditional Medicare.
- Can I enroll in a Medicare Advantage Plan during Medicare open enrollment?
Yes, Medicare open enrollment from October 15-December 7 is the time when Medicare beneficiaries can switch between Medicare Advantage Plans and enroll in a Medicare Advantage Plan if they are eligible for Medicare during this period.
- What prescription drug coverage do Medicare Advantage Plans include?
Many Medicare Advantage Plans also include prescription drug coverage. This means they provide Part D prescription drug plan coverage in addition to Medicare Parts A and B medical coverage. Advantage beneficiaries do not need to enroll separately in a Part D Plan.
- How can I find what Medicare Advantage Plans are available in my area?
You can use the Medicare Plan Finder tool on Medicare.gov to see what plans are available in your zip code and compare options. The tool lists all Medicare Advantage Plans offering coverage for your preferred doctors or facilities.
- Do Medicare Advantage Plans typically have networks of doctors you must use?
Yes, most Medicare Advantage Plans require you to use doctors and facilities that accept the plan. You may have to travel farther or pay more to visit providers not in the plan’s network. Advantage plans restrict coverage for their preferred doctors and hospitals included in their network.
- Am I able to switch between Medicare Advantage Plans if I’m not happy with my health insurance?
Yes, if you are enrolled in a Medicare Advantage Plan and find that advantage plan is not meeting your needs or you wanted all your Medicare benefits covered under standard Medicare, you have the option during Medicare enrollment periods to switch to another Advantage Plan or return to Original Medicare and add a Medicare Supplement Plan and part D prescription drug Plan.
- What is a Medigap Plan and how does it differ from Medicare Advantage?
A Medigap Plan, also called Medicare Supplement insurance, is private insurance that supplements remaining healthcare costs like copays, coinsurance, and deductibles not covered under traditional Medicare. Medicare Advantage Plans on the other hand are an alternative to traditional Medicare where beneficiaries transfer all their Medicare benefits to a private insurance plan operated by a Medicare Advantage insurer.
- Can someone who takes Medicare sign up for a Medicare Advantage Plan at any time?
No, people in Medicare Advantage can only enroll or switch plans during the initial enrollment period surrounding their 65th birthday and Medicare enrollment, or the open enrollment period from October 15-December 7. Outside these windows, they would need a special enrollment period to sign up.
- Does a Medicare Advantage Plan cover the same benefits as regular Medicare?
Medicare Advantage Plans typically met or exceed the coverage for benefits that are covered under standard Medicare like hospital insurance, medical insurance, and sometimes prescription drug coverage depending on the specific plan and region. However, Advantage Plans may exclude some providers from their network or charge higher costs to visit out-of-network providers.
- How can I learn more about my options under Medicare Advantage versus staying with traditional Medicare?
The medicare.gov website and the Medicare Plan finder tool are good resources for researching and comparing Medicare Advantage Plans versus fee-for-service Medicare and Medicare Supplement Plans in your area. Centers for Medicare and medicaid services also publish reports on satisfaction levels and healthcare access/outcomes for Advantage Plan enrollees versus those retaining current Medicare benefits without enrollment in a private Medicare Replacement Plan.