Medicare Pain Points

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Medicare Pain Points

As seniors become more tech-savvy, their expectations from Medicare payers and providers become more sophisticated as well. Tech-savvy Medicare members, for example, expect programs, plans, and resources to be both personalized and accessible. Though unsatisfactory digital or online services are not the primary reason seniors switch plans, they are one of the considerations for plan switching.


  • Seniors are becoming more proficient in the use of technology, and while digital savviness is increasing, expectations are growing and the odds of health plan switching are becoming higher as well.
  • More and more Americans aged 65 and older, including two-thirds of the members of Medicare Advantage, are using digital technologies. Among the digital technologies tech-savvy seniors use are mobile applications, Internet resources, and health monitoring devices.
  • At present, over two-thirds of seniors go online. The percentage of seniors who go online has been growing for over five years now.
  • Like other tech-savvy consumers, tech-savvy seniors have certain expectations when it comes to their well-being and health. They expect resources, including those provided by Medicare providers, to offer both accessibility and personalization. To remain competitive, health insurers must take steps to satisfy these expectations.
  • However, around 50% of seniors indicate that plans do not offer resources that are tailored to their goals, interests, and preferences.
  • A large percentage of seniors express interest in virtual health and artificial intelligence (AI) doctor interactions, yet most of them have not been given the opportunity to engage in such interactions. For example, many seniors are willing to use an AI doctor to get information outside of a doctor's appointment (59%), navigate healthcare services (54%), get emergency advice (41%), but no more than 1% of seniors have ever interacted with an AI doctor.
  • Sixty-five percent of Medicare members have signed up for their plan's online portal, but 47% indicate that the portal hardly responds to their queries online. Also, 77% of Medicare members use digital health monitoring tools (e.g., pill trackers, fitness trackers, and blood pressure monitors), yet only 9% of Medicare members indicate that their plan offers integration of data from these tools. These figures suggest that certain digital expectations are not being met.
  • With the reforms the government is making, however, it appears efforts to address the gap between expectations and reality are underway. For example, regulations relating to telehealth services have been recently loosened by The Centers for Medicare and Medicaid Services (CMS). Before, Medicare Advantage members can only access telehealth services at designated healthcare facilities; now, they can access these services at home.


  • Almost 6 out of 10 plan members of Medicare Advantage indicate they would contemplate switching to another plan. Should they decide to switch, they prefer plans that offer "low out-of-pocket costs, prescription drug coverage and in-network access to their providers."
  • While these three items are the primary considerations of plan switchers, seniors also want programs and resources that support the physical, social, emotional, and financial aspects of their well-being and health. As mentioned previously, these programs and resources should provide accessibility and personalization, two things that can be achieved through digital technologies.
  • Plan providers should take into account that 52% of Medicare Advantage members and 47% of traditional Medicare members prefer to communicate with their respective health plans via email. They should also consider that younger seniors favor email communications over phone communications.
  • Tech-savvy seniors may switch to Medicare plans that offer communications and experiences tailored to their preferences. Plans that offer multi-channel communications, including SMS and email, may attract more seniors.
  • However, only a very small percentage of Medicare members cite dissatisfaction with digital or online services as their reason for switching plans. Only 1% of Medicare members do so.
  • The most common reason for switching is the lack of value for money, with 62% of Medicare members citing this reason. Seven percent of Medicare members cite poor experience with their respective plans as their reason for switching.
  • Three percent of Medicare members indicate that they would be willing to stick with their plan if it has better digital or virtual services on offer.
  • Information and communication issues are the aspects on which Medicare Advantage plans get rated very lowly by members.


  • The market for Medicare Advantage and value-based care is only expected to grow in succeeding years. This means that the switch to the value-based system of reimbursement will only continue, and fee-for-service payments will decrease further in number. It is expected that, in five to ten years' time, over 50% of seniors will be enrolled in Medicare Advantage plans and the number of enrollments will increase by 33%.
  • This trend has a direct impact on the revenues of providers. Clinical laboratories, for example, will have fewer patients under the fee-for-service system. Providers that do not offer the best value will likely lose revenue.
  • According to Michael Abrams, a Numerof and Associates managing partner, “Medicare Advantage plans will result in more pressure on providers [such as clinical laboratories] and hospitals to focus on the cost of care.”
  • The trend will also result in narrower provider networks, which, in turn, will pressure providers to give in to the cost and quality demands of payers. Providers will also face the challenge of stricter utilization management.

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