In Medigap.com’s Medicare satisfaction survey of more than 750 Medicare beneficiaries ages 65+, we attempted to uncover their thoughts, understanding, and concerns about their Medicare coverage. The survey shows good knowledge and satisfaction from Medicare beneficiaries about their coverage.
Medicare Satisfaction Survey results
Several areas showed some concerns. Specific areas need a clearer understanding of plan benefits and expanded Medicare coverage for medical services. We asked a series of questions to understand how these Medicare beneficiaries view and understand their coverage.
We’re going to go over the results of the survey in detail. Our survey was among individuals on Medicare 65 or older. The majority fell within an income range of $25,000 to $99,000. However, other income ranges are included.
Do you know what form of Medicare coverage you currently have?
When it came to knowing what type of Medicare coverage the respondents had, the results showed that 3% didn’t know what kind of coverage they had. In addition, more Medicare beneficiaries choose enrollment in Medicare Advantage rather than a Medicare Supplement plan.
These results are surprising, seeing how Medigap plans are more comprehensive and simpler to understand and use. Another interesting fact was that more than twice as many had a stand-alone Part D prescription drug plan than those on a Medigap plan.
This indicates that 151 individuals surveyed may be at significant risk for unexpected bills with only Medicare Parts A and B in addition to the prescription drug plan. Original Medicare has significant holes that Medicare Supplement plans help cover.
Importance of knowing your coverage type
There are several reasons why knowing your coverage type is important. Different coverages perform differently from when you can change plans, how the insurance works, and even how you pay for it. Let’s break down how these work with different plans.
Original Medicare
When on Original Medicare, you must understand that it doesn’t cover everything. Medicare coverage is only for items deemed medically necessary. So, Medicare wouldn’t cover items or services like routine dental, vision, and hearing coverage and elective surgeries.
Medicare Part A handles all Inpatient costs, such as hospital stays, skilled nursing facilities, and hospice care. Medicare Part B covers durable medical equipment, outpatient services like labs and doctor office visits, and medications administered at outpatient facilities.
Costs associated with Original Medicare include a large reoccurring deductible for inpatient services, copays after so many days inside an inpatient facility, a small annual deductible, and then a 20% coinsurance and excess charges.
Part D prescription drug plans
Medicare Part D plans are coupled with Original Medicare and Medicare Supplement plans to provide coverage for prescription medications filled at the pharmacy. These plans must follow the guidelines set forth by the Centers for Medicare & Medicaid Services Part D standard model.
You can only make changes to these plans during the Annual Enrollment Period unless you have a life event that qualifies for a Special Enrollment Period. Drug formularies, plan premiums, and medication costs change annually.
So it’s wise to review and possibly change your plan each year. This annual review will help ensure you always have the right coverage for your prescription medication needs.
Medicare Advantage plans
Medicare Advantage plans to provide another way to receive your Medicare benefits. These plans combine your Medicare benefits into an all-in-one program that’s simple to use.
Like the Part D plans, you can only change during qualifying enrollment periods. You can’t add, drop, or change your plan outside an active enrollment period.
In addition to being required to cover the same items and services as Original Medicare, these Part C plans can include your prescription drug coverage and additional benefits not included by Original Medicare. Plan availability will vary depending on where you live and your chosen carrier.
Medicare Supplement Plans
Medicare Supplement plans will fill the gaps in coverage from Original Medicare. These Medigap benefits don’t change from carrier to carrier or depending on where you live. The only difference in coverage is the Plan letter you select. Other than that, the only differences are the monthly premium and the quality of the company you choose.
You can change a Medicare Supplement plan anytime, as long as you medically qualify. The only reason that could stop you from enrolling is if you’re medically ineligible. If you have a disqualifying medical condition, you can change plans or enroll during the Medicare Supplement Open Enrollment Period.
Or If you have a life event that triggers a Guarantee Issue right, or you live in a state with a specific Guarantee Issue or Open Enrollment rule.
How familiar are you with your plan’s coverage?
When it came to familiarity with their plan, about 10% indicated that they were unfamiliar, with only 20% feeling very familiar with the coverage. However, about 70% felt like they had a decent understanding of their plan.
These answers indicate that there needs to be a more straightforward explanation of how these healthcare plans work provided for Medicare beneficiaries. Some individuals struggle to determine if they can use certain healthcare providers and how the benefits work. In many cases, the misunderstanding of benefits is due to a poor explanation from the carrier or agent.
Common items and services that individuals aren’t familiar with
Original Medicare, Medigap, and Part D are pretty straightforward. However, Medicare Advantage plans have their own rules and costs and aren’t standardized. Every program has different costs including copays, deductibles, and services. Since these plans have additional benefits not covered by Medicare, they provide a new layer of confusion.
Medicare Advantage plans must cover the same items and services as traditional Medicare. So you can ease your mind about something not covered on a MA plan that Original Medicare would otherwise cover. However, the way they are covered could be different. In many cases, the plan will require authorizations and referrals for services; if you don’t obtain these, tprogramlan won’t cover the item or service.
That and sometimes the insurance carriers will have these additional benefits that are very vague on what they’re for and how you use them. There needs to be a more consistent and straightforward explanation from the insurance companies on these added benefits.
Do you feel your plan covers all of your medical essentials?
Most beneficiaries indicate that their plan meets their essential needs regarding medical essentials. However, just over 30% felt the opposite.
For beneficiaries who feel like their program isn’t meeting their needs, they should speak with a licensed insurance agent to see what other plan options are available to meet their essentials more thoroughly.
Not everyone has the same needs, so it’s vital to choose and plan that caters to your situation.
Medicare coverage for medical essentials
So with medical essentials, we were a little taken aback that many felt their plan didn’t cover their needs. However, when we speak with beneficiaries to clarify which essentials, most refer to dental and vision coverage.
While Medicare doesn’t feel these items are medically necessary, many beneficiaries feel these are essential to staying healthy and aren’t wrong. When a dentist gives you an oral exam, they can see the early stages of many health conditions, and it can help catch problems early.
Are you satisfied with your Medicare coverage?
83.51% of beneficiaries participating in our Medicare Satisfaction Survey said their plan satisfies their needs, while 16.49% said they weren’t happy with their coverage.
While it’s great that so many are satisfied with their coverage, we feel there is room for more improvement in the Medicare industry to help those who aren’t.
For example, the benefits schedules are often in separate documents, and it’s not easy to find details for some benefits and plan extras. This results in underusing the benefits of the plan for covered services.
Reasons why Medicare beneficiaries aren’t satisfied with their coverage
While it was great to see that the large majority of beneficiaries are happy with their coverage, we want to understand what the individuals who aren’t satisfied want. In many cases, it comes back to getting a proper presentation of their chosen plan.
The unsatisfied beneficiaries will typically not understand their program and are not using all the benefits included. Typically these individuals are on Medicare Advantage plans which are more complex than the standardized Medicare Supplement plans.
Have you considered changing to a different Medicare plan?
What’s a bit baffling about this question is that just under 23% of those that answered the Medicare Satisfaction Survey said they would consider changing plans. This does make sense based on the percentage that’s happy with their program, but with benefits changing annually on Medicare Advantage plans, it’s wise to review those plan options annually.
With Medicare Supplement plans, the benefits don’t change year over year, but the rates do increase. It’s wise to review your plan options at least every five years regarding Medigap options.
Reasons why you should review and consider changing Medicare plans
Everyone on Medicare should check their plan from time to time. Individuals enrolled in Medicare Advantage and Part D prescription drug plans should inspect them annually. Medicare Supplement enrollees should review if they get a rate increase higher than usual or when trying to lower costs.
The reasons for this review are as follows:
- Medicare Advantage and Part D plans have changes yearly on their networks, covered prescriptions, and costs.
- Medicare Supplements increase in premium annually in most cases.
If you aren’t reviewing your plan, you may be paying more than you should and may stay with coverage that’s no longer best for your needs.
Are you concerned about the cost of your medical expenses?
As we discussed above, the majority haven’t considered changing their plan, and it’s nearly 50/50 for those concerned about medical costs. To combat this concern, you can review plans often, especially if your needs change.
Medigap plans limit your out-of-pocket costs significantly regarding Medicare expenses. Medicare Advantage plans have fixed copays for most services and have an annual maximum out-of-pocket.
Concerns Medicare beneficiaries have with medical expenses
The cost of healthcare is a nationwide concern for Americans. Medicare beneficiaries are more concerned about this sentiment due to being on a fixed income.
Depending on where they live and the plan options available caters to the decisions they make for coverage.
When someone is on a Medicare Supplement plan, they typically aren’t worried about the cost of medical services but rather the monthly premium that will increase annually.
Those enrolled in Medicare Advantage plans are a little more apprehensive. This is because costs for different items and services are significantly different.
However, the costs for most services are outlined in the plan materials with a fixed copay, not to mention MA plans limit how much you can spend on an annual basis to protect you from high medical bills.
Have you ever felt overwhelmed trying to understand what is and is not covered by your plan?
The federal Medicare program can be a bit confusing. It seems when people have Medicare explained properly understand how Medicare works.
This provides a better chance of not feeling frustrated when trying to understand their plan.
The most confusion is trying to gather information from multiple sources.
Everyone has a slightly different way of explaining things, so it tends to lead to confusion.
Why is Medicare so confusing?
Medicare itself isn’t really that confusing. However, everyone learns and teaches differently.
That’s why it’s best to find a reputable source to learn from as opposed to learning from five or six different people or companies.
Generally, having those additional perspectives and potential biases towards one option or another adds to the confusion, not lessen it.
Do you have any essential medical needs that are not covered by your plan?
Nearly 30% of participants in the Medicare Satisfaction Survey said that they have essential needs that aren’t met. If your needs aren’t satisfied with medical care, you should look into another plan.
With many plan options to select from, don’t feel obligated to stay with a program that’s not meeting your needs.
Some Medicare beneficiaries require ongoing treatment for chronic health conditions and having the right treatment plan is necessary.
Items and services not covered by Medicare
As mentioned above Medicare doesn’t cover everything. However, if Medicare covers the item and service you need, you can get coverage on your Medicare plan.
Items that Medicare doesn’t include are items like custodial care, nursing homes, and alternative medicine.
Have you ever not sought out medical services because you were unsure if your plan covered them?
Getting the medical care you need promptly is essential to a healthy life. If you’re concerned about if your plan covers essential items, contact customer service and ask them.
There is no need not to get treatment because you’re unsure. You can also speak to a licensed insurance broker to see which plans may cover the needed service better.
If it’s for ongoing treatment or medical care, it’s wise to search for better coverage options. Your Medicare plan must also cover items that Medicare covers.
Common reasons why Medicare beneficiaries don’t use their coverage
Most commonly, beneficiaries don’t use their coverage because they’re afraid of the costs, don’t understand the benefits, or don’t have reliable transportation to the appointments.
Fortunately, these are situations that can be overcome with a little effort. Costs are outlined in the plan materials.
You can look up nearly every cost before you need the service. can’t find it in the material, flip over your health insurance card and give customer service a quick call to get the answer.
Many Medicare Advantage plans include transportation benefits to help you get to and from approved locations such as physicians’ offices.
Last but not least, if you’re having problems understanding how to use your plan, a licensed insurance agent or the plan’s customer service should be able to help explain the benefits to you more thoroughly.
What do you wish your plan had better coverage for?
We hear day in and out that dental coverage from Medicare plans is something that’s lacking.
The results of our Medicare Satisfaction Survey showed that dental coverage is still among the top reasons that beneficiaries feel like their Medicare coverage is lacking.
While some plans provide robust coverage, to be satisfied, many beneficiaries enroll in a separate dental program.
A few close runner-ups are vision and hearing.
This is no surprise since Medicare doesn’t include routine dental, vision, or hearing, as it’s not considered medically necessary.
This is why many Medicare enrollees purchase a separate dental, vision, or hearing plan to satisfy their needs.
Where can Medicare improve coverage?
Our Medicare Satisfaction Survey results show Medicare’s most significant shortcomings include dental, vision, and hearing benefits.
Although Medicare doesn’t provide coverage for these services, beneficiaries can receive these benefits with a Medicare Advantage plan.
However, the coverage in many cases is not comprehensive enough for most beneficiaries to get the needed services.
There are many pros and cons between the plan options. Some things are far more convenient with Original Medicare, while the MA plan benefits can be very robust.
Get help finding a Medicare plan that fits your needs properly
If you’re looking to find coverage that matches your needs better, trying to save money, or just getting started in Medicare, we can help.
Give us a call or fill out our online rate form to review plan options in your area today! We can connect you with a licensed insurance agent that specializes in Medicare. Ensuring you get the best coverage for your needs.
Related Content
