Support and Internet Use in Navigating Medicare Plans Among Older Americans

Abstract

U.S. counties offer an average of 42 Medicare Advantage plans [1] and 14 stand-alone prescription drug plans [2], which vary in benefits, provider networks, operations (e.g., prior authorizations), and quality. Insurance decision-making may be particularly challenging for older adults given their complex health needs [3]. Insurance decision-making tools and resources are available online, but older adults may have limited access or comfort [4, 5]. To support older adults' enrollment choices—critical decisions with enormous financial and health implications—it is important to understand the resources they use to make insurance-related decisions.

We used the 2015–2023 National Health and Aging Trends Study (NHATS), a nationally representative, longitudinal survey of Medicare beneficiaries aged 65 or older. Surveys were fielded between May and December each year except in 2023 (March 2023–April 2024), with response rates of 50.8%–96.0%. Respondents were asked whether they changed Medicare plans (i.e., supplemental, prescription drug, Medicare Advantage) in the past year and, if so, whether anyone helped. Respondents were also asked whether they used the internet to handle Medicare insurance matters (e.g., comparing plans, looking up coverage, filing claims).

From 2015 to 2023, we examined prevalences of two outcomes: receiving help changing Medicare plans and using the internet for insurance matters. For cohort comparability across years, we limited the analysis each year to respondents aged 71 or older. We tested the trend using a linear probability model with year included as a continuous variable and additional binary indicators for years 2021, 2022, and 2023 to allow for deviations from the 2015 to 2020 linear trend during the COVID-19 pandemic; we did not include an additional binary indicator for the year 2020 since the survey asked about respondents' receipt of help and internet use in the past year. Then we used logistic regression to examine factors associated with each outcome, adjusting for respondent characteristics (Table 1). For this analysis, we used the 2022 survey and included respondents aged 65 or older to generate nationally representative estimates for older adults of all ages, calculating predicted probabilities and marginal effects. We used NHATS analytic weights, adjusted for complex survey design. Statistical significance was set at two-tailed p < 0.05; analyses were performed using Stata, version 18.0 (StataCorp LLC).

The proportion of respondents (N = 44,467 respondent-years) who changed Medicare plans was stable at 10%–12% each year from 2015 to 2022 and increased slightly to 13.5% in 2023 (p = 0.01; Figure 1). Among those who changed, approximately 50% received help until 2020, but this dropped to 40% by 2022 (p = 0.02). The proportion of respondents who used the internet for insurance matters slowly increased to 15% by 2020, then to 30%–31% in 2022 and 2023 (p < 0.001 for all).

Among 5900 respondents aged 65 or older in 2022, 13.4% (N = 711) changed Medicare plans; of these, 38% received help (Table 1), coming from partners (30.5%), other relatives (18.6%), or non-relatives (53.3%). The probability of receiving help was higher among other race and ethnicity (i.e., Asian, Pacific Islander, Native Hawaiian, American Indian, Alaska Native, or other) relative to non-Hispanic White and increased with the number of caregivers and among respondents with probable dementia but did not differ by other characteristics. Thirty-three percent of respondents used the internet for insurance matters, with a higher probability among those who were younger, had at least a college education, had higher income, had more caregivers, and did not have dementia.

Among U.S. older adults who changed Medicare plans in 2022, only 38% received help with this decision and 33% used the internet to handle Medicare-related matters. While the latter has grown since 2015, it is unclear whether the steep increase through 2022 and 2023 will continue. Social isolation related to the COVID-19 pandemic may explain the findings that, from 2021 through 2023, fewer older adults received help changing health plans while more turned to the internet for insurance-related matters.

In each of the 9 years analyzed, no more than half of older adults reported receiving help changing Medicare plans. Given the large financial implications of this decision and the enormous number of options available, it may not be ideal that so few older adults report help with this complex task, though they may be unaware of resources available (e.g., Medicare-funded State Health Insurance Assistance Programs) to assist [6]. While insurance companies and government-funded decision aids (e.g., Medicare Plan Finder) offer insurance-related resources online, just one-third of older adults reported using such technology for insurance matters, suggesting a mismatch between where insurance companies and Medicare beneficiaries prefer to conduct business. A Limitation of our study is that we did not know the specific insurance-related matters older adults dealt with using the internet.

Study concept and design: Lei, Maust. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Lei, Maust. Critical revision of the manuscript for important intellectual content: All authors. Approval of the submitted version: All authors.

The authors declare no conflicts of interest.