More than one in eight Americans is age 65 or older. Since many older Americans suffer from one or more chronic health problems, it is especially important for them to understand their health care options and make informed choices about health insurance coverage. However, plowing through the maze of choices available to them is not always easy. For many, the choices include up to 10 standardized commercial supplemental plans, various forms of Medicare managed care plans, basic Medicare, employer-sponsored retirement supplemental options, and a Medicare private fee-for-service option.
In a large study of Medicare beneficiaries in the Kansas City area, researchers examined whether a set of information materials improved beneficiaries' knowledge of Medicare and helped guide them in their choice of a Medicare health plan. The materials included versions of the Medicare & You handbook and the Medicare Consumer Assessment of Health Plans Study (CAHPS®) survey report. The results of the study, which was supported in part by the Agency for Healthcare Research and Quality (HS09218), are described in three articles, which are summarized here.
Harris-Kojetin, L.D., McCormack, L.A., Jael, E.M., and Lissy, K.S. (2001, fall). "Beneficiaries' perceptions of new Medicare health plan choice print materials." Health Care Financing Review 23(1), pp. 21-35.
These researchers examined what dually eligible (for Medicaid and Medicare) Medicare beneficiaries who participated in seven Kansas City focus groups thought of the pilot version of the Medicare & You 1999 handbook (part of the National Medicare Education Program) and the 1998 Medicare CAHPS® survey report for the Kansas City area. The 52-page Medicare handbook included information about Medicare costs and benefits, new managed care options, patient rights, and multiple information sources. It also provided comparative cost and benefit information for local Medicare health maintenance organizations (HMOs) and worksheets to facilitate plan comparisons. The CAHPS® survey report provided comparative results of a survey showing how Medicare beneficiaries in the Kansas City area assessed the quality of care they received from five local Medicare HMOs.
Beneficiaries generally had a positive response to both booklets. They saw the handbook as a comprehensive reference tool, which they could save and consult over time as the need arose. They saw the survey report as a short, easy-to-read booklet. They felt, however, that neither booklet could stand alone, and that they would need more information before making a plan choice.
More highly educated beneficiaries in the focus groups found the handbook and survey report easier to understand than those with less education (this is corroborated by the outcome evaluation survey results from the Kansas City area of 97 vs. 67 percent and 96 vs. 64 percent, respectively). Beneficiaries in the focus groups found most useful the survey's two-page guide on how to compare plans using the CAHPS® data and the handbook's four-page worksheet, which provides a more detailed comparison process than the report.
Some participants said that they were more likely to fully read the survey report than the handbook because the report was short and easier to read than the handbook, suggesting that more information is not necessarily better. The booklets were not entirely responsive to the needs of beneficiaries with special situations, such as those with disabilities or people eligible for both Medicare and Medicaid, who may need targeted supplemental materials.
McCormack, L.A., Garfinkel, S.A., Hibbard, J.H., and others. (2001, fall). "Beneficiary survey-based feedback on new Medicare informational materials." Health Care Financing Review 23(1), pp. 37-46.
This study reported results of a survey of 951 new and 1,156 experienced Medicare beneficiaries in the Kansas City area assigned either to a control group or one of three treatment groups. The first treatment group received the 8-page Medicare & You tri-fold bulletin; the second treatment group received the longer Medicare & You 1999 handbook; and the third treatment group received both the handbook and the Medicare CAHPS® survey report. Treatment group members were interviewed immediately after they were mailed the Medicare & You materials in fall 1998. Control group beneficiaries received no study information and were interviewed before the mailing.
Beneficiaries in all three treatment groups were significantly more likely to find the information they received useful compared with control group members, who only received information outside the study. Eighty percent of Medicare information beneficiaries rated the Medicare & You materials as good to excellent at helping them understand the advantages and disadvantages of the different Medicare options, with more highly educated beneficiaries finding the materials more helpful. About 4 in 10 beneficiaries found them easier to understand relative to information they had received in the past. However, nearly half found them to be about the same level of difficulty, and 5 percent found them more difficult.
Three-fourths of respondents found the CAHPS® survey report very or somewhat easy to understand, just over 10 percent found it very or somewhat hard, and the remainder said it was neither hard nor easy. The differences in reported levels of understanding by beneficiary education were not significant. Beneficiaries who knew more initially about the Medicare program and had greater exposure to other sources of information were more likely to find the materials useful. Those who received the lengthier and more complex materials and survey report did not view them as more useful than those who received the shorter materials. The study's findings suggest room to improve the print materials, as well as a need for other kinds of information for this population.
McCormack, L.A., Anderson, W., Kuo, M., and others. (2001, fall). "Measuring beneficiary knowledge in two randomized experiments." Health Care Financing Review 23(1), pp. 47-62.
This article reports the results of two different surveys of the Medicare population—an evaluation of the pilot version of the Medicare & You 1999 handbook conducted in the Kansas City area and a national evaluation of the Medicare & You 2000 handbook. The surveys were developed to measure beneficiary knowledge of the Medicare program and related health insurance options, use of Medicare information sources, and attitudes about health plan choice and decisionmaking. Both surveys included two groups: a control group that received no information as part of the study and a treatment group that received the handbook.
Overall, the researchers found modest gains in Medicare-related knowledge in both the Kansas City and the national evaluation studies. The Kansas City survey revealed that before the mailing, only 50 percent of beneficiaries were aware of how the benefits in original Medicare compared with benefits offered by other Medicare health care plan options; 65 percent understood Medicare's relationship with other Medicare health insurance plans; and 75 percent were knowledgeable about the availability of original Medicare. However, almost 80 percent recognized that original Medicare will not pay for all health care costs, and that they could remain in the health care plan of their choice. After the mailing of the handbook, beneficiaries' knowledge was significantly greater in three of these five areas.
In the national survey, there was a significant increase in knowledge levels in 12 of 15 questions as a result of receiving the mailed materials. Respondents gained between 2 and 17 percentage points in the multi-item knowledge indexes that served as the dependent variable in multivariate models. However, most respondents were able to answer correctly only 5 of the 15 survey questions, indicating a generally low level of beneficiary knowledge. Also, they lacked knowledge in some of the most critical areas—being able to differentiate between original Medicare and Medicare managed care, issues in obtaining a Medigap policy, and knowing how to get more information on the Medicare program.