MONDAY, Aug. 29 (HealthDay News) -- Although older Americans
have many Medicare options to choose from, they may not be making
good decisions about their coverage, according to a new study.
Some seniors -- particularly those with impaired brain function
-- can become overwhelmed by the variety of complex Medicare
Advantage plans available to them, preventing them from finding the
best plan to fit their needs, according to researchers from Harvard
Medical School's department of health care policy.
"We are providing the most complex insurance choices to the very population that is least equipped to make these high-stakes decisions," said Dr. J. Michael McWilliams, assistant professor of health care policy and medicine at Harvard Medical School and a general internist at Brigham and Women's Hospital, in a university news release.
"Most other Americans choose from just a few health plans, but elderly Medicare beneficiaries often have to sift through dozens of options," McWilliams said.
The Medicare Modernization Act of 2003 increased the number of
private plans participating in the Medicare Advantage program,
which purports to usher in more competition, lower premiums and
result in better benefits, including prescription drug
In assessing how these changes affected enrollment in Medicare
Advantage compared to traditional Medicare, researchers examined
nearly 22,000 enrollment decisions made by more than 6,600
participants over the course of four years, taking into account
their mental status and the plans available to them.
The study, published online and in the September print issue of
Health Affairs, found that enrollment in Medicare Advantage increased when the number of Medicare Advantage plans available to seniors was fewer than 15.
When there were more than 30 plans available, however,
enrollment dropped. The researchers pointed out that 25 percent of
U.S. counties offer more than 30 Medicare Advantage options.
Elderly people with impaired brain function were much less
likely to understand and take advantage of the wide array of
benefits offered by Medicare Advantage plans and instead were more
likely to choose the traditional Medicare program by default,
according to the report.
Given the increasing numbers of older Americans with Alzheimer's
and other forms of dementia, the findings should prompt
policymakers to establish better ways to assist seniors in making
the right choice for them, researchers said. That could include
offering fewer choices or helping them make better decisions based
on those options.
"Efforts to limit choice and guide seniors to the most valuable options could especially benefit those with cognitive impairments, who without more help appear to be leaving money on the table," said McWilliams. "Better enrollment decisions could in turn strengthen competition by rewarding high-value plans with more enrollees."
Not all experts would agree that the seniors who chose Medicare
over Medicare Advantage were making the wrong choice, however.
Medicare Advantage plans have serious drawbacks compared to the
original Medicare, according to the Medicare Rights Center (MRC), a
non-profit consumer advocacy group.
Among the problems with Medicare Advantage the MRC cites are
higher costs for skilled nursing care, home health care and
in-patient hospital costs; unstable private plans that may suddenly
stop coverage; restrictions in the choice of doctors, hospitals and
other providers members can choose; and problems getting urgent or
The U.S. National Institutes of Health provides more information