Academic journal article Health Care Financing Review

Beneficiaries' Perceptions of New Medicare Health Plan Choice Print Materials

Academic journal article Health Care Financing Review

Beneficiaries' Perceptions of New Medicare Health Plan Choice Print Materials

Article excerpt

INTRODUCTION

Today, more than 1 in 8 Americans, or 34.5 million adults, is age 65 or over. By 2030, older adults are projected to outnumber those under age 18 (Fowles, Duncker, and Greenberg, 2000). Medical advancements have increased our life span, but they cannot ensure quality of life (extending our health span). In fact, increasing numbers of older adults have chronic health conditions. In this context, making sure that older Americans understand their health care options and can make informed choices about their health insurance coverage is an increasingly important societal issue.

An intersection of forces--including the public policy environment, the dynamic health care financing and delivery market, and the challenges Medicare beneficiaries face in processing unfamiliar, complex information--all point to the need to develop effective ways to inform, assist, and educate beneficiaries about their Medicare plan choices. The Balanced Budget Act (BBA) of 1997 legislated new health insurance options for Medicare beneficiaries through the Medicare+Choice program; and required CMS for the first time to give beneficiaries local comparative health plan information on all options available to them. Medicare beneficiaries are now being offered a greater variety of health insurance options, to add to an already complex mix. For many beneficiaries, the choices may now include up to 10 standardized commercial supplemental plans, various forms of Medicare managed care plans, basic Medicare, employer-sponsored retirement supplemental options, and a Medicare private fee-for-service option.

This increasing complexity comes at a time when research finds that Medicare beneficiaries do not understand: (1) today's current health care system; (2) the differences between managed care (e.g., network) and fee-for-service insurance options; (3) that managed care plans are both insurer and care deliverer; or, (4) that plans play a role in access to and quality of care (Eppig and Poisal, 1996; Hibbard, Jewett, Engleman, and Tusler, 1998; McGee, Sofaer, and Kreling, 1996). This is not surprising considering that age 65 is the first time many persons have to navigate these choices on their own, without help from an employer (Frederick Sneiders Research, 1995; Gibbs, 1995). The Medicare+Choice plan lock-in (scheduled to become effective beginning in 2002) also would remove the safety valve feature that currently enables beneficiaries to change plans monthly if they make a plan choice that does not work well for them.

One result of the increased plan choices available is the large amount of information that beneficiaries need to process to make meaningful plan comparisons. Considering the different types of information needed to make an informed choice--cost, coverage, providers, quality, and other relevant comparative information--it is easy to foresee that beneficiaries can easily get lost in information. Some policy-minded researchers question whether the informed choice policy approach is even appropriate for Medicare beneficiaries, in light of empirical findings that many beneficiaries have difficulty using comparative plan information (Hibbard et al., 2001) and lack basic knowledge of their health plan choices (Hibbard et al., 1998). One thing is certain--more information, in and of itself, will not necessarily improve the quality of beneficiaries' plan decisions. The way that comparative plan information is presented to Medicare beneficiaries is key to their understanding and use of it and its influence on their decisionmaking (Harris-Kojetin et al., 2001).

While CMS launched the National Medicare Education Program (NMEP) in 1996, prior to the 1997 BBA mandate, the NMEP supports the educational objectives of the BBA. The Medicare & You handbook is an integral component of the NMEP. In preparation for implementing the NMEP, CMS pilot tested Medicare & You in five States and the Kansas City metropolitan statistical area (MSA) in fall 1998. …

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