What Do Medicare Beneficiaries Value About Their Coverage?

Introduction

As the Medicare program nears 60 years old, enrollment in traditional Medicare and Medicare Advantage, or MA, is about evenly split.¹ As policymakers chart Medicare’s future, it’s important to understand the value people receive from their coverage under the two coverage options. In this data brief, we present findings from the Commonwealth Fund 2024 Value of Medicare Survey to compare the experiences of beneficiaries with traditional Medicare to those with Medicare Advantage.

Most analyses have found that the federal government has always paid MA plans more than what it would cost to cover similar people in traditional Medicare. Although estimates vary, one study finds that plans were overpaid by more than $27 billion in 2023.² These overpayments have raised questions about whether MA enrollees receive greater value that merits the extra cost to Medicare. MA plans typically provide benefits not covered by traditional Medicare, such as some coverage for vision, hearing, or dental services, and they can help to coordinate enrollees’ care. They also limit enrollees’ out-of-pocket costs for Medicare-covered benefits. Traditional Medicare, meanwhile, allows beneficiaries to see any provider without the need to obtain prior authorization or a referral — which MA plans often require — and offers a larger selection of Part D plans for prescription drug coverage. The net effect of these trade-offs has been an important question for both beneficiaries and policymakers.

The Commonwealth Fund survey, conducted in collaboration with SSRS between November 6, 2023, and January 4, 2024, asked a nationally representative sample of 3,280 Medicare beneficiaries age 18 and older about the value of their care as measured by access to benefits, services, providers, care coordination, and satisfaction (affordability of care was not a primary focus, as recent studies have probed this topic extensively). We also took a closer look at the experiences of beneficiaries with greater health care needs. An additional battery of questions was asked only of beneficiaries in MA plans, since they were not relevant to beneficiaries in traditional Medicare. For further detail, see “How We Conducted This Survey.”

Survey Highlights

• Whether enrolled in Medicare Advantage or traditional Medicare, about two in three beneficiaries overall said their coverage has fully met their expectations. Those who said it fell short of expectations pointed to a lack of coverage for needed services, high costs, or uncertainty about what benefits are covered.
• Larger shares of beneficiaries in MA plans than in traditional Medicare reported they experienced delays in getting care because of the need to obtain prior approval (22% vs. 13%) and couldn’t afford care because of copayments or deductibles (12% vs. 7%). By other metrics, access to needed health care was similar. For example, more than a third of beneficiaries in each type of Medicare coverage said they had to wait over a month to see a doctor.
• Three in five beneficiaries in MA plans and one-quarter in traditional Medicare said they were asked to undergo a health assessment, which most frequently resulted in a discussion with their doctor. Few said it resulted in any changes to their care plan or in more services or benefits being offered.
• Seven in 10 beneficiaries in MA said they used some of their plan’s supplemental benefits in the past year; three in 10 did not use any. Four in 10 reported using their dental or vision benefits or an allowance for over-the-counter medications.

Survey Findings

Beneficiaries in both traditional Medicare and Medicare Advantage (MA) reported challenges in accessing care in the past two years. But more beneficiaries in MA plans said they experienced delays in getting care because of the need to obtain plan approval to get a test or procedure. A larger share of those in MA plans also said they could not afford care because of copayments or deductibles. The survey did not assess differences in health care needs by type of coverage.

Access to Benefits, Services, and Providers

Among beneficiaries reporting a challenge in getting care, about a third in MA plans (33%) and a third in traditional Medicare (32%) said the problem occurred when trying to access primary care (data not shown). Smaller shares said the challenge occurred when trying to get surgery (13% for MA plans and 15% for traditional Medicare), physical therapy or rehabilitative care (13% for both), or cardiology care (13% vs. 10%; data not shown).

About one in six beneficiaries said they were told to go to urgent care because their provider had no appointments available, with no significant difference between people with MA or traditional Medicare (16% vs. 18%; data not shown).

People’s need to find a new doctor did not differ by type of Medicare coverage. Among beneficiaries who needed to find a new doctor in the past year, about three in 10 in MA or traditional Medicare reported doing an online search to identify one. About one-third in MA (34%) said they used their plan to find their new doctor. Beneficiaries in traditional Medicare were more likely than those in MA to rely on friends and family for referrals.

Health assessments are often used to gather information about beneficiaries’ health status, identify any unmet care needs, or develop coordinated care management activities for chronic conditions. People in MA plans more commonly reported being asked to undergo a health assessment than those with traditional Medicare. About six in 10 people in an MA plan (62%) said they were asked to undergo a health assessment; this included four in 10 (41%) who said they had an assessment and one in five (21%) who said they did not (data not shown). In comparison, 27 percent of people in traditional Medicare said they were asked to undergo a health assessment, including 23 percent who reported having one and 4 percent who did not. Among MA enrollees who had an assessment, 53 percent said it was done at home while 43 percent said it was done in their doctor’s office; for people with traditional Medicare, the respective shares were 13 percent and 83 percent (data not shown). Two percent or less in either MA or traditional Medicare reported receiving the assessment via video conference or over the phone.

Most beneficiaries in Medicare Advantage or traditional Medicare who had a health assessment said it resulted in a conversation with their doctor. A small share said the assessment prompted a change in their care plan or the availability of new services or benefits. More often, beneficiaries said it was not clear how the assessment was used. Additionally, some beneficiaries may have confused their annual wellness exam with a health assessment.

The federal government uses information collected from health assessments to adjust payments to MA plans to account for plan enrollees’ health status and expected health care utilization.³ Benchmark payments for accountable care organizations (ACOs) — groups of doctors, hospitals, and other providers that jointly coordinate care to the Medicare patients they serve — are also adjusted for the health status of their patients, giving ACOs the incentive to conduct these assessments.⁴

MA plans can help beneficiaries schedule visits and screenings, whereas traditional Medicare relies instead on physician offices and ACOs to communicate directly with beneficiaries. More than four in 10 MA plan enrollees reported that their plan helped them to schedule appointments and screenings for them. Some visits and screenings, such as for flu vaccines and eye exams, are tied directly to the quality-bonus payments that MA plans can receive. Wellness exams and primary care visits, meanwhile, can help ensure that beneficiaries receive many of the other tests that are linked to plan payments.

MA plans provide supplemental benefits that traditional Medicare does not cover. The vast majority of MA plans offer some coverage for dental and vision care.⁵ Most also provide allowances for over-the-counter medications, hearing care, and fitness benefits, and some provide allowances for groceries or meal-delivery services. Restrictions on use of these benefits, as well as the extent of coverage, vary across plans.⁶ (Respondents were not asked which benefits their plan offered out of concern over the accuracy of responses.)

Seven in 10 people (69%) in MA plans indicated they had used one or more of their plan’s supplemental benefits in the past year. Dental care, vision care, and an allowance for over-the-counter medications were the benefits most often used. Of the three in 10 who said they did not use any supplemental benefits in the past year, 63 percent said they hadn’t needed the benefits, 24 percent said they did not know what benefits their plan offers, 9 percent said the benefits are hard to use, and 4 percent said it costs too much to use the benefits; 6 percent cited additional reasons (data not shown).

MA plans can also provide benefits to help people manage daily tasks. One-fifth (18%) of beneficiaries with traditional Medicare and a similar share (20%) of those in MA plans reported that completing tasks such as housework, meal preparation, medication management, and shopping was very or somewhat difficult because of a health problem (data not shown). Among people in MA plans who reported this difficulty, one-third (33%) said their plan offered to help with these tasks. The survey did not ask beneficiaries whether they received this assistance, whether it helped them manage their health conditions, or how much they were required to pay for it.

Administrative Burdens

Getting medical bills paid by their Medicare plan is one of the often time-consuming administrative tasks that beneficiaries must handle themselves. A somewhat larger share of beneficiaries in MA plans compared to traditional Medicare reported a delay in getting health care in the past 12 months because of administrative paperwork (9% vs. 6%; data not shown) or difficulty obtaining approval from their Medicare coverage (15% vs. 9%; data not shown). Among beneficiaries who reported a challenge related to coverage of their care, the time spent dealing with it did not differ significantly between MA and traditional Medicare; only a minority reported spending more than 20 hours requesting prior approval (24% in MA vs. 21% in traditional Medicare; data not shown). Sixty-five percent of beneficiaries in either MA or traditional Medicare said they eventually received the care that was delayed.

Care Coordination

About three-quarters of beneficiaries reported they coordinate their own health care, with no significant differences by coverage type. Somewhat more beneficiaries in MA plans than in traditional Medicare said their primary care doctor helped coordinate their care (38% vs. 33%). Few beneficiaries said their Medicare plan coordinated their care.

More beneficiaries in MA plans (84%) than in traditional Medicare (79%) said their usual source of care was a primary care practice. Relatively few beneficiaries overall said their usual care was provided by a hospital clinic, walk-in clinic, or community health clinic, an emergency department, or a Veterans Affairs facility (data not shown).

Perceived Value of Coverage

Two-thirds of beneficiaries overall said their coverage fully met their expectations, with one-third indicating it fell short. There were no significant differences between the two types of Medicare coverage.

Among beneficiaries who said their Medicare coverage did not fully meet their expectations, lack of coverage for needed care, uncertainty about benefits covered, and high costs were the reasons most frequently cited. There were no differences between MA plan or traditional Medicare enrollees.

The majority of beneficiaries — and, in some cases, the vast majority — said that high-quality care, access to providers, low out-of-pocket costs, and access to supplemental benefits were all important features of their Medicare coverage. Nearly all beneficiaries, regardless of coverage type, said high-quality care and access to providers are important. Somewhat larger shares of people in MA than in traditional Medicare said low out-of-pocket costs are important (95% vs. 89%) and access to supplemental benefits is important (88% vs. 74%).

Beneficiaries with Greater Health Care Needs

Some Medicare beneficiaries need more health care than others and tend to experience more barriers to receiving this care. These include people under age 65 who qualify for Medicare because of a disability or health condition and people 75 and older. They also include people who are dually eligible for Medicare and Medicaid, somewhat more than one-third of whom are younger than 65.⁷ Beneficiaries in these groups typically have complex health conditions and often lower incomes. About half of dual-eligible beneficiaries in MA are enrolled in Special Needs Plans, which offer more supplemental benefits than other plans, including more help with coordinating care.⁸

Among these groups of beneficiaries with greater health care needs, the challenges they reported in accessing benefits, services, and providers were similar whether they were in MA plans or traditional Medicare. With regard to the health assessments that many Medicare beneficiaries are asked to undergo, the survey found a similar share of higher-need beneficiaries and other beneficiaries were asked to receive a health assessment, and few reported that the assessment resulted in a change in their care plan or the availability of new services or benefits. There was also little difference in reported use of supplemental benefits between higher-need beneficiaries and other beneficiaries in MA plans. Most higher-need beneficiaries said they largely manage their care themselves, and more than one in three said their care was coordinated by their primary care doctor, with similar findings for MA and traditional Medicare.

A significantly larger share of dual-eligible beneficiaries in MA plans than in traditional Medicare said their coverage fully met their expectations. Among those who indicated their coverage fell short, uncertainty about benefits covered and lack of coverage for needed care were the reasons most frequently cited. This finding seems to be primarily driven by differences in age among survey respondents, with a larger share of dual-eligible beneficiaries under age 65 in traditional Medicare than in MA. We found age has a more significant impact than the type of insurance, when holding other demographic variables constant. Only about four in 10 beneficiaries under age 65 said their Medicare coverage fully met their expectations, with no significant difference between those in MA and in traditional Medicare.

Discussion

Whether enrolled in Medicare Advantage or traditional Medicare, beneficiaries reported similar access to benefits, services, and providers as well as similar challenges and experiences. Overall, one-third of beneficiaries indicated their coverage fell short of their expectations, which raises questions about both MA plans and traditional Medicare. Finding ways to improve the value of Medicare coverage, including making care more accessible and affordable, can help ensure that the program meets the needs of all beneficiaries, irrespective of their coverage choices.