Are Most People Happy with Medicare Advantage Plans?

This is the big question, right?

Everyone's trying to sell you something but if you could only hear from people already on the plan!

In fact, most people choose a Medicare plan based on a friend or neighbor's retelling of their experience with their plan (seriously..this is a big driver of plan selection).

Everyone's health situation is different so that's not the best approach and we already addressed the problem with selecting a plan based on what brokers or carriers might be pushing.

As part of our "triple threat" process for selecting an Advantage plan, we can lean heavily on the last piece:

• Low or no monthly cost
  
• Max out-of-pocket under $1000
  
• Star Rating of 4 or more

That Star Rating is our way to establish if a given plan is well regarded by its actual members!

We can also zoom out and look at the total market. Let's go there.

We'll address these questions:

• What percentage of the Medicare market goes with Advantage plans
  
• What is the satisfaction level for Advantage plans
  
• What is the average and best Start Rating for Advantage plans
  
• How to compare Advantage plans according to member happiness
  
• How to avoid bad Advantage plans

Let's get started!

What percentage of Medicare market goes with Advantage plans

This is really fascinating.

From 2019 to 2021 (a two-year period), the percentage of the Medicare market that chooses an Advantage plan went from roughly 40% to 50%!

Urban areas were much more likely to have an Advantage plan than rural areas which makes sense.

With HMOs (most Advantage plans), you need lots of people and providers to make them work.

We discussed how to use this in selecting a plan in our Advantage Plan Insider's Guide or How to pick the best Advantage plan.

The alternative is to have either just Medicare alone or a Medicare Supplement. We looked at both of those options versus Advantage plans.

The real risk of just Medicare alone is the 20% coinsurance that has no cap.

For a $100K bill, you're responsible for $20,000. It's important to cover that gap with either an Advantage plan or supplement.

More on the comparison between the two here.

We expect the percentage of people who go with Advantage plans to peak at around 70% by 2030 simply due to the crazy rise in healthcare costs (primarily hospital and RX).

Just look at the trajectory...doubling since 2007:

https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2022-enrollment-update-and-key-trends/

If anything, it's accelerating since Covid.

Advantage plans do a much better job of containing costs based on it's structure (HMO).

Now let's look at the important question. What do actual members think of their plans?

What is the satisfaction level for Advantage plans?

JD Power has a pretty review of satisfaction generally which you can find here:

https://www.jdpower.com/business/press-releases/2022-us-medicare-advantage-study

This reflects 2022 data (there's always a lag) but some interesting info can be gleaned from it. The issue is that it reflects nationwide ratings and Advantage plans are very much a regional game as we go through in our Calfiornia Advantage Plan Comparison.

We'll focus on a California take.

In California, there are three carriers that are near or above the average in the above chart but this is nationwide date:

• Kaiser
  
• SCAN
  
• Alignment

The average (nationwide) is 809 out of 1000 points. So a B grade.

This partially matches the current California Market share:

Keep in mind, Kaiser's unique in that you have to stay within their network, whereas the other carriers contract with private/public hospitals, doctors, and medical groups.

So, it really comes down to who you want access to (which is true for Advantage plans in general).

We personally focus on the dominant carriers because there's generally a direct correlation between carrier size and network size which is the key limiting issue with Advantage plans.

Now...some carriers will list their satisfaction level or the percentage of members that renew their policy (a measure of satisfaction).

For example, SCAN is clocking at 91% which is pretty impressive! We're working on putting together a workup of this measure for the major carriers we work with.

You have to really be careful as everyone seems to have a horse in the race. We looked at pretty big reviews online and they're basically pushing one carrier and it turns out they get paid as a result.

We're independent agents (zero cost to you) who work with the biggest carriers and our system will even show you ALL the plans in your area...even those we're not contracted with. It's the right thing to do!

One thing that's completely unbiased is...the Medicare Star Rating!

What is the average and best Start Rating for Advantage plans?

Medicare keeps a running tally of how each plan performs called the Star Rating. This is updated each year which is good since things can swing fast in this market with lesser players trying to gobble up market share and then fading away!

You have a 0-5 rating with 5 being the best across these categories:

• Member Experience - a total score
  
• Customer Service - ease of dealing with plan
  
• Plan Performance - customer complaints essentially
  
• Chronic Conditions - how good is a carrier at managing ongoing health issues
  
• Staying Healthy - screenings, vaccines, labs etc to stay healthy

Just look at how this is driving plan enrollment:

https://www.mckinsey.com/industries/healthcare/our-insights/assessing-the-medicare-advantage-stars-ratings

Our minimum is 3.5. We would prefer 4 or higher though. We want to at least be above that level.

Keep in mind that a carrier may have a score for the whole State but really, your area is what matters. Even plans within a carrier's offering can differ in an area.

The best way to see this is to run the quote below and each plan will have a star rating available:

The reason it's local has to do with the network. If a carrier has a small or poorly performing network in a given area, it should reflect as people are frustrated with access to care.

The average rating for Advantage plans was 4.15 in 2022 so ideally, you want to hit that or higher.

There are even 5.0 rated plans in many areas and that's a pretty high compliment (excellent reviews).

Again, it's dependent on the area so run your quote below. We'll send you the doctor/RX entry link and an "opt-in" called a Scope which is required to quote Medicare Advantage and/or Part D.

3.5 is the floor. 5 is the goal. Around 4 is the average. By Medicare Rules, this star rating must be provided with any enrollment in Advantage so not getting this info is a big red flag!

So...how do we put this all together to find the best Advantage plan?

How to compare Advantage plans according to member happiness

Here's our checklist for finding the best plan if we were doing it for ourselves!

First, run your quote:

Make sure to enter your RX and doctor info for Advantage plans and/or Part D:

Second, look at the Star Rating above each plan. 3.5 is the floor but over 4 is better and 5 is best.

Now, compare the max out-of-pocket and monthly premium!

This is the "Triple Theat":

Of course, you can reach out to us with any questions at help@calhealth.net or (888) 496-9439.

The #1 complaint with new Advantage members is that their doctors are not in the plan. #2 is medications not being covered or paying more than expected.

On the agent side (see how to find a good Advantage agent), it's that they were enrolled in a plan without intending to do so.

This is just a result of a bad agent (there are some out there which is why the rules keep mounting!).

Check our google reviews on that front:

We have a big review on how to compare the Advantage plans but if you combine the following, you'll be in good shape:

• Run quote with doctor and medication included
  
• Stick to the strongest carriers that have good Star Ratings
  
• Combine the lowest cost with the lowest max out-of-pocket (don't get misled by the bells and whistles!)
  
• Get assistance from someone with great Google Reviews!

Let's flip it around. How do we avoid bad Advantage plans?

How to avoid bad Advantage plans

Coming for the opposite angle, here's our checklist (or warning signs):

• Plans with Star Ratings under 3.5 (a direct measure of whether customers are happy)
  
• Plans with very high max out of pockets (say $3-4K or higher); the D-SNP plan max may be different though - check with us!
  
• Plans are being pushed really hard and only by themselves (you should see at least 2-3 carriers to make a good decision - we are certified with the 6 biggest that make up the majority of the market)

One important note! You may be able to move to a 5 Star plan if available in your area after open enrollment one time during the year! Reach out to us at help@calhealth.net, and we can help you with this.

Usually, people find themselves in bad plans because it was actively sold to them and they felt pressured or just didn't understand how to compare the different options. We had a candid converation on why these plans are pushed so hard.

A good agent should help you walk through the pros and cons of different options and carriers.

The only way to establish if an agent has a good track record is to look at a third-party review system like Google Reviews.

Trying to navigate such a complicated and crowded market like Advantage plans, especially in big markets like Los Angeles, etc is really tricky. Even for agents, there's a lot to consider!

Get help that's vetted. See many options...at least 2-3 carriers. Make sure your medication/doctors are in the plan. Stick to well-reviewed plans (at least 4 stars).

Otherwise, the satisfaction level on top-rated Advantage plans can be pretty high!

There's a built-in incentive for these plans to really deliver or it will show in their Star rating and they'll be penalized.

Good plans get rewarded (such as the 5 Star ability to move mid-year) and more.

Lean on this Star Rating when you run your quote here: