When Americans are asked what they think about Medicare, they generally rate the program highly. But how do people 65 and older who are actually in Traditional Medicare or the alternative Medicare Advantage (MA) plans from health insurers really feel about it?
That’s a somewhat different story, as recent surveys from health researchers at The Commonwealth Fund, KFF, Brigham & Women’s Hospital and Retirement Living revealed.
While beneficiaries in Traditional Medicare and Medicare Advantage plans say they’re largely happy with each program, they also report challenges and frustrations.
Some Medicare Advantage beneficiaries were disappointed by the realities of major reasons they enrolled in the plans.
One of the surveys’ biggest surprises: Although Medicare Advantage plans heavily promote the supplemental benefits they offer and that Traditional Medicare can’t—dental, hearing, and vision—a sizable percentage of MA members don’t use them.
Here’s a dive into the survey findings:
Medicare beneficiaries are mostly happy with their health insurance and happier than people with employer-sponsored health coverage. In KFF’s 2023 Survey of Consumer Experiences with Health Insurance, 92% people aged 65+ rated as “excellent” or “good” the overall performance of Medicare’s health insurance and the availability and quality of medical providers. By contrast, only 80% of people with employer-sponsored health insurance graded it “excellent” or “good.”
“When we asked people to rate their health insurance, overall, people were generally pretty happy. But people with Medicare really stood out as overwhelmingly happy,” says Lunna Lopez, senior survey analyst at KFF. “People with employer-sponsored insurance have more challenges with cost and insurance not paying for something they thought was going to be covered.”
Although Medicare beneficiaries told KFF they were generally pleased with their health insurance, “that doesn’t mean they don’t have issues with it,” says Lopez. She believes many people on Medicare are “kind of grateful and feeling at least more secure in having health coverage to begin with.”
KFF’s survey found that people in Medicare were more likely to report problems with coverage of their prescription drugs than those with employer-sponsored insurance. Some 27% said Medicare either didn’t cover their medications or required a very high co-pay for them.
Overall, people in Medicare Advantage plans are as likely to say their coverage met their expectations as people in Traditional Medicare. The Commonwealth Fund’s 2024 Value of Medicare Survey found that about two in three beneficiaries in MA plans and in Traditional Medicare said their coverage fully met their expectations.
The high marks from Medicare Advantage members might seem surprising considering that, unlike Traditional Medicare, their plans often have limited networks of doctors and hospitals and typically require prior authorization approval to see specialists.
But The Commonwealth Fund’s Vice President for Medicare, Gretchen Jacobson, noted that Medicare Advantage enrollment in PPOs—preferred provider organizations that let members get care covered if they go outside their network—has been growing. Medicare Advantage HMOs (health maintenance organizations) require beneficiaries stay in network for care.
Medicare Advantage beneficiaries were, however, almost twice as likely to report delays getting care than people with Traditional Medicare. In The Commonwealth Fund survey, 22% of MA beneficiaries said they experienced delays due to prior approval vs. 13% of those with Traditional Medicare.
But 65% of people with Medicare Advantage and Traditional Medicare whose health care was delayed said they eventually did receive the care.
Whether the delays were a nuisance or worsened patients’ health is unknown. However, Jacobson says, “if you have a significant delay in care, depending on your condition, that can really result in poorer health outcomes.”
The biggest challenges reported by those in Traditional Medicare and Medicare Advantage: Out-of-pocket medical costs and health services they needed but weren’t covered.
“The gaps in Medicare coverage can really be notable,” says Jacobson. “It’s not only the cost-sharing requirements, deductibles and premiums, but also the services that aren’t covered at all, which includes long-care.”
For people with Traditional Medicare, those services include dental, vision and hearing as well. “Many people over the age of 65 really need those benefits,” Jacobson says.
Medicare Advantage members were more likely to run into health care affordability issues than people with Traditional Medicare, The Commonwealth Fund found.
Although MA plans often tout themselves as being “$0 premiums,” that doesn’t mean $0 co-pays or deductibles. In the new Commonwealth Fund survey, 12% of people with Medicare Advantage said they couldn’t afford care because of co-payments or deductibles vs. just 7% of people with Traditional Medicare.
This difference is especially striking because The Commonwealth Fund’s 2022 Biennial Health Insurance Survey and Retirement Living’s 2023 Medicare Advantage Satisfaction Index found that a limit on out-of-pocket costs was a chief reason people gave for enrolling in Medicare Advantage plans.
Medicare Advantage plans’ claimed advantage over Traditional Medicare for coordinating health care for members didn’t ring true. “Most Medicare beneficiaries [in our survey] said they coordinated their own care regardless of whether they were in Medicare Advantage or Traditional Medicare,” says Jacobson.
But Medicare Advantage members said their plans were helpful for scheduling doctor’s appointments and wellness exams.
The much-touted supplemental benefits of Medicare Advantage are often going unused. Although people with Medicare Advantage have told The Commonwealth Fund that supplemental benefits were a main reason they chose the private insurers’ program over Traditional Medicare, the group’s new survey revealed that three in 10 members didn’t use any of those benefits in the past year.
“It could be that the supplemental benefits may not be the benefits people really need or value,” says Jacobson. Indeed, 63% who didn’t use their supplemental benefits said they hadn’t needed them. Another 24% didn’t know what benefits their plan offered and 13% said those benefits were hard to use or cost too much.
Similarly, according to a new study by Dr. Lisa Simon and Dr. Christopher Cai, published in JAMA Network Open, Medicare Advantage members have very low rates of dental use, even though 97% of MA plans offer dental coverage.
The Medicare Advantage members surveyed were no more likely to see the dentist as people in Traditional Medicare, which doesn’t cover most dental care.
“We were surprised,” says Simon, a dentist and M.D. who is a physician at Brigham and Women’s Hospital in Boston. “In theory, we should be seeing a huge difference between the populations of people in Medicare Advantage plans and people in Traditional Medicare and whether they can access dental care. We don’t see that at all.”
Why aren’t more people in Medicare Advantage using their dental benefits?
For one thing, their plan’s coverage and reimbursement for dental care may be minimal, with high deductibles and co-pays, leading members to skip dental visits.
“Supplemental benefits can really vary from plan to plan, not only which types of benefits are offered, but also the extent of the coverage. That may not be apparent to people,” says Jacobson.
Simon sees two other possible explanations.
Medicare Advantage members’ favorite dentists and eye doctors might not be in their plans’ network. Also, they might not realize they have dental coverage.
Simon doubts that last possibility is a major reason Medicare Advantage beneficiaries aren’t going to the dentist, though.
“We know that 84% of television ads for Medicare Advantage advertise dental plans,” she says. “I think they’re drawing people in with this.”
A Centers for Medicare and Medicaid Services (CMS) proposal might help address the lack of take-up of Medicare Advantage supplemental benefits.
The new CMS rule, expected to take effect in 2025, aims to help ensure that people in Medicare Advantage plans know about the benefits they haven’t been taking advantage of and how to use them.
CMS plans to start sending them an annual, personalized “mid-year enrollee notification” of supplemental benefits they haven’t used in the prior six months. This notification will also tell the beneficiaries how to access those benefits.
“It’s difficult to put the onus on people to know everything their plan offers when documents and explanations of benefits can be so lengthy,” says Jacobson. “It would really help if there were more succinct ways for them to know all of the benefits covered under their plan.”
In KFF’s survey, about a quarter of people on Medicare said it was difficult for them to understand what their insurance would and wouldn’t cover.
Simon believes the CMS proposal may help raise the use of dental services by people with Medicare Advantage plans, but not by much.
“I think there are structural and implementation-based barriers that are keeping people away from the dentist,” she says.
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