MEDICARE+CHOICE: Seniors Need Better Information

      Only 11% of seniors have adequate knowledge to make an informal choice between HMOs and traditional plans under the Medicare+Choice program, according to a study in the current Health Affairs. Researchers from the University of Oregon conducted telephone surveys with 1,673 seniors from five cities with high managed care penetration, half of whom were in enrolled in Medicare HMOs and half in fee-for-service plans. Seniors were asked what sources they used for information about HMOs and how much they knew about the differences between FFS plans and HMOs. HMO advertisements were found to be the most common information source for Medicare risk enrollees. Traditional Medicare enrollees, however, are "60-100% more likely [than HMO members to] to rely on consumer groups or newspaper/magazine articles for information." The researchers found that 30% of respondents know "almost nothing about HMOs." Surprisingly, members of this group were more likely to be enrolled in HMOs, were older, had lower incomes, lower education, spent more nights in the hospital and visited the doctor's office less frequently. Another 59% had some knowledge of HMOs, but the information is considered inadequate to make informed decisions. Researchers found seniors' decisions about enrollment to be influenced by income, number of information sources available and knowledge of options. Seniors who rely on "information from consumer groups and newspapers or magazines had significantly higher knowledge scores than those who did not use those sources."

Conclusions
      The authors found few beneficiaries were informed about choices: "Even those who use multiple information sources to learn about health plans often have less-than-adequate knowledge." They found it "surprising that HMO enrollees ... are the least well informed." With Medicare+Choice decisions coming soon, the researchers write, these "findings raise serious concerns about how beneficiaries will cope with the coming expanded array of Medicare options. They also underscore beneficiaries' vulnerability to aggressive marketing." The authors call for education outreach efforts that educate seniors about major differences between managed care and fee-for-service plans, such as the tradeoff between lower premiums under an HMO but more physician choice with a FFS plan. Once this understanding is in place, the authors call for specific, but not overwhelming, comparisons between plans. The authors cast doubt on the feasibility of a Balanced Budget Act of 1997 provision that would "lock" beneficiaries into the plan of their choice by 2003, given current lack of knowledge among seniors. They conclude, "A commitment to an informed consumer-choice policy suggests that lock-in should not occur until and unless there is empirical evidence that beneficiaries actually understand the choices that they are being asked to make" (Hibbard, et al. Health Affairs, November/December).