What Beneficiaries Value Most in Medicare Advantage Plans

It doesn’t matter if you’re selling kitchenware, travel packages, or health insurance. If you don’t know what your market values the most in the products you’re selling, you’re missing out on sales.

Right now, more than half of all Medicare beneficiaries have a Medicare Advantage plan. By 2033, MA enrollees could make up 62 percent of that same group, according to projections from the Congressional Budget Office.

In the coming years, a big chunk of MA business will be up for grabs. Understanding what beneficiaries value the most in these private plans will be the key to securing your share of it.

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Monthly Premiums vs. Provider Networks

When shopping for an MA plan, consumers often look for a low-cost plan that includes their preferred health care providers. But what if they can’t find such a plan? How do they compromise?

In 2014, KFF held small focus groups of seniors in four cities to better understand how seniors choose and change their MA plans. They found that some seniors would enroll in a cheaper plan, even if it meant they couldn’t see their usual doctors, while others would rather have a plan allowing them access to certain hospitals or treatment facilities.

Almost a decade later, KFF focus groups from 2023 found that beneficiaries continue to value plans with low premiums. Those who chose or were considering an MA plan often cited zero or low premiums as the top reason for selecting one, followed by low cost-sharing requirements for services. Whether their doctors are in network continues to impact on beneficiaries’ decisions as well.

Participants’ feelings about the matter appeared to vary based on their relationships with their doctors. People who have been going to the same providers for years may feel assured their providers will respect their privacy and successfully put them back on the road to recovery if needed. But when push comes to shove, some people will readily pay more for a plan just so they can see their preferred providers and have the peace of mind that comes with knowing their life is in good hands.

Some people will readily pay more for a plan just so they can see their preferred providers.

Star Ratings vs. Brand Names

CMS implemented the star rating system in 2008 to help beneficiaries assess the quality of Medicare plans and make plan selection easier. However, it seems that star ratings may not influence beneficiaries’ decisions as much as those who know about the star rating system would think.

KFF’s 2014 focus groups found that participants didn’t understand the system and that star ratings didn’t majorly impact their decision to purchase a plan. Instead, those studied seemed to care more about the plan having a “recognizable name.”

Surprised? Consider this: According to a 2013 study conducted by Nielsen, 60 percent of shoppers around the world with internet access favor purchasing new products from a familiar brand instead of a new brand. A more recent study from Salsify tells us that 46 percent of U.S. consumers will pay more for brands they trust.

Fast forward to 2023 and KFF found that participants still generally don’t use Medicare’s star rating system for coverage decisions but do select plans based on insurance providers they feel comfortable with or like the reputation of.

Just as they trust their providers, people trust brand names. They may also give more weight to their own experiences than others’ experiences, especially others whom they don’t know. So, if your client had a good experience with a certain carrier before turning 65, there’s a good chance they’ll be interested in sticking with that insurer after they’ve turned 65, even if the government doesn’t rate its Medicare plan 5 out of 5 stars.

Star ratings may not majorly impact a person’s decision to purchase a plan.

Convenience vs. Practicality

You likely recommend MA plans that meet your clients’ budget, medical needs, travel habits, and preferences. Your clients, on the other hand, may believe certain plans are the best for them based on other reasons. For instance, some participants in KFF’s 2014 focus groups stated they enrolled in a plan to have the same coverage as their spouse.

Would you believe that several participants also reported that they don’t review or switch plans during the Annual Enrollment Period? It’s true. In a 2013 KFF study, many beneficiaries indicated they’d rather get by in their current plan, even if it means switching to different prescription medications.

Convenience plays a large role in Americans’ lives, especially today where one can communicate with others instantaneously, take pictures, and control home appliances with a mere cell phone. Above all else, people value their time. If there’s an easier way to do something, they’ll frequently take it. The same runs true for determining their health insurance plan.

Numerous Medicare eligibles report choosing and changing health plans to be a confusing, overwhelming, and frustrating task. Consequently, some beneficiaries will enroll or stay in a plan simply because it’s easier than trying to compare their options and figuring out how to change their coverage.

A 2022 KFF study, found that most MA or PDP enrollees did not switch plans between 2019 and 2020 and that, between 2008 through 2020, the annual rate of MA-PD enrollees who switched plans ranged from six percent to 12 percent. What’s more, participants in KFF’s 2023 focus groups stated the availability of extra benefits in MA plans, such as dental and vision, attracted them to MA plans. Time has shown us it’s convenient to, not only stay put, but also, select a plan with extra benefits included versus having to buy other plans!

Many beneficiaries would rather get by in their current plan, even if it means switching prescription meds.

What This Means for You

As an agent selling Medicare products, it’s vital to look out for your clients’ best interests and take a holistic approach in narrowing down their plan options.

You may encounter clients focused on a brand-name carrier or wanting to enroll in a plan because a family member is in it, but you should do your research and weigh all the factors for them. You’re the expert — they’ve trusted you to help them. It’s also important you educate your clients throughout the entire process. Make sure they understand their options and the star rating system and explain to them why certain plans work better for them than others, among the other topics CMS requires agents to discuss before enrolling clients in a plan…

Everybody has different preferences and needs. Some clients you meet will want access to their usual providers, a free gym membership, and dental, vision, and hearing benefits; others will only want a $0-premium plan without the bells and whistles. By asking your prospects what matters most to them when it comes to their health plan up-front, you can streamline sales. And by making follow-up calls to your clients, you can ensure they’re in the best plan if their needs or preferences have changed.

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Trust is a powerful driving force in the decision-making process. If you find ways of cultivating prospects and clients’ faith in your business, there’s no limit to how much it will grow.

A modified version of this post was previously published in the April 2017 issue of California Broker Magazine.

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