BMA: MA Member Satisfaction Is High, Prior Authorization Denials Low

Medicare Advantage beneficiaries express high levels of member satisfaction, an eHealth survey found.

eHealth surveyed nearly 2,850 individuals online toward the end of May 2022.

Nearly two-thirds of Medicare Advantage beneficiaries were “very satisfied” with their coverage (63 percent) and a total of 88 percent of Medicare Advantage members stated that they were satisfied.

Six percent of beneficiaries stated that they were not satisfied with their Medicare Advantage plans.

Most beneficiaries said that they would recommend Medicare Advantage to others in their lives (86 percent), while three percent said they would not recommend the plans and eleven percent said they were unsure.

The survey compared Medicare Advantage plans and Medigap or Medicare Supplement policies by surveying current former Medigap enrollees to compare their previous coverage to their current Medicare Advantage plans. 

Six out of ten enrollees expressed greater satisfaction with their Medicare Advantage coverage than their Medigap policies. A quarter of respondents were “equally satisfied.” 

One of the key reasons that beneficiaries cited for this difference in satisfaction was cost—nearly seven out of ten respondents who had previously been covered by Medigap said that Medigap was too expensive. Other respondents (25 percent) noted that Medigap policies lack prescription drug coverage, unlike Medicare Advantage plans, and said that this was the primary reason for their higher satisfaction.

Former Medigap enrollees were not the only ones who preferred Medicare Advantage plan coverage to their previous health insurance plans. Six out of ten beneficiaries who had other types of Medicare coverage prior to enrolling in Medicare Advantage indicated higher member satisfaction in Medicare Advantage (61 percent) and a quarter were equally satisfied (24 percent).

Cost was a significant barrier for Medicare Advantage beneficiaries. Without Medicare Advantage coverage, nearly half of the respondents (48 percent) stated that they would not be able to afford coverage as comprehensive as Medicare Advantage plans’.

The survey also inquired about consumers’ experiences with prior authorizations in Medicare Advantage, which has become a point of contention in the industry after the Office of Inspector General (OIG) reported Medicare Advantage plans have incorrectly delayed or denied prior authorizations and payment requests for higher profits.

However, 77 percent of the respondents stated they had not had a prior authorization or medical claim request denied in their Medicare Advantage plans. Ten percent of respondents did not know if they had experienced a prior authorization or claim denial.

Thirteen percent of respondents stated that they had experienced a denial either for a claim or prior authorization request. The majority of these cases (43 percent) said that the denial was related to coverage requests for services that were not covered under the plan. Another 15 percent stated that the service for which they requested coverage was deemed not medically necessary.

For 15 percent of the cases in which a claim or prior authorization request was denied, the payer ultimately covered the cost.

Respondents learned about Medicare Advantage primarily through channels outside of the government. Most beneficiaries (69 percent) became informed about Medicare Advantage through online research, an insurance agent, or a form of media such as television, radio, or printed content.

Previous research has indicated that insurance agents may provide information on a limited number of Medicare Advantage plans.

“This expansive survey of more than 2,800 Medicare Advantage enrollees confirms what we already know: Medicare Advantage remains highly popular among the audience that matters most – beneficiaries – despite misleading attacks from outside groups that seek to undercut the care and coverage that more than 28 million Americans rely on,” Mary Beth Donahue, president and chief executive officer of the Better Medicare Alliance, said in response to the survey results.

“Further, this survey reaffirms that, overwhelmingly, prior authorization is applied appropriately and selectively as a clinical tool to coordinate care for beneficiaries.”