Nearly 7 in 10 Medicare Beneficiaries Do Not Compare Coverage Options During Open Enrollment

With open enrollment less than a month away, a new KFF analysis suggests that the vast majority of the nation's 67 million Medicare beneficiaries will not shop around among the coverage options for 2025 or switch plans. It's a decision that could have a significant impact on enrollees' coverage and costs.

The analysis of federal data shows that nearly 7 in 10 Medicare beneficiaries (69%) did not compare their Medicare coverage with other Medicare options during the program's annual open enrollment period for coverage in 2022. Enrollees in traditional Medicare were slightly more likely to skip shopping around than those in Medicare Advantage plans (73% vs. 65%).

The Centers for Medicare & Medicaid Services recommends that beneficiaries compare their options because coverage and costs can vary widely, especially among Medicare Advantage plans that now enroll more than half of all eligible Medicare beneficiaries. From one year to the next, Medicare Advantage plans can change their premiums, cost-sharing requirements, provider networks, or prior authorization requirements. For beneficiaries who simply stay put in their existing plan, such changes could lead to unexpected, avoidable costs and disruptions in care.

The new analysis examined the subset of Medicare beneficiaries enrolled in a Medicare Advantage plan, finding that 43% of enrollees did not review their own plan's coverage during the open enrollment period to see whether there would be changes for 2022 to their monthly premiums, deductibles, co-payments, or other out-of-pocket expenses. The share not reviewing their own plan for changes in costs was even higher among enrollees in fair or poor self-assessed health (50%), enrollees who are Black (50%) or Hispanic (65%), and enrollees ages 85 and older (57%).

Similarly, 44% of Medicare Advantage enrollees did not review their current plan for changes to the kinds of treatments, drugs, and services offered for 2022.

New changes for 2025 include prescription drug provisions in the Inflation Reduction Act of 2022 that will lower out-of-pocket costs for all Part D enrollees, including a new $2,000 cap on out-of-pocket spending starting in January. In response, Part D plan sponsors may make changes to plan premiums, formularies, and cost sharing - making it especially important for beneficiaries to compare their prescription drug options during open enrollment.

In the past, many have not. The analysis shows that 82% of enrollees in Medicare Advantage prescription drug plans and 69% of enrollees in stand-alone Part D prescription drug plan did not compare their plan's drug coverage with drug coverage offered by other plans in their area for 2022.

More broadly, relatively few beneficiaries use Medicare's official information resources. The analysis finds that just a quarter (26%) reported calling the toll-free 1-800-Medicare helpline, four in 10 (42%) reported visiting the Medicare website, and slightly more than half (54%) reported reading some or parts of the Medicare & You handbook.

Also released today is KFF's What to Know about the Medicare Open Enrollment Period and Medicare Coverage Options. It provides information about the kinds of changes Medicare beneficiaries can make to their coverage, how supplemental coverage can factor into decisions, how Medicare supports for low-income people relates to coverage decisions, how the features of traditional Medicare compare to Medicare Advantage, and how prescription drug coverage plans vary.

The Medicare open enrollment period runs from October 15 through December 7.