The Affordable Care Act (“ACA” aka “Obamacare”) will bring new opportunities and challenges to health care consumers. With more people receiving coverage on the individual market, they will need to find ways to select health plans that meet their needs. Consumerism in the Medicare market predates Obamacare with choices of Medicare Advantage and Medicare Prescription Drug plans. In light of the movement toward individual choice, HealthPocket decided to look at the effect of brand awareness on decision making and focused on one well known and widely used branded Medicare Advantage program. We found that plans bearing the AARP brand in the Medicare Advantage market on average fall short of the industry in two measures of plan quality.
This report looked at 578 Medicare Advantage contracts with a particular focus on the government’s star rating and the overall opinion of the plan based on a survey of enrollees in that plan. The goal of this research is to compare how one of the strongest brands in the industry, AARP and its endorsed carrier, UnitedHealth, perform in these high level quality metrics compared with the universe of plans.
The Medicare Advantage program has been successful in many ways, including enrollment. There are now 14.4 million people enrolled in Medicare Advantage plans, and that figure has grown by almost 10 percent since 2012.1 Medicare Advantage market share represents over 28 percent of the Medicare eligible population.2 By contrast, the insurance industry reports that 10.2 million people had Medigap plans, which supplement benefits to traditional Medicare, at the end of 2012. This marketplace doesn’t show the same growth pattern seen in the Advantage market.3
Consumers have complex choices to make when deciding between traditional Medicare and Medicare Advantage. Once they conclude that an Advantage plan can best meet their needs, they then have to navigate an array of options available to them. There is much research regarding the paradox of choice and consumer decision making generally.4 One specific study of the Medicare Advantage market showed the market within a particular region generally grows when choice is limited to fewer than 15 plans, but could in fact shrink if choices become too numerous.5 The article expressed particular concern that beneficiaries with cognitive challenges could miss better plan opportunities because of having too much choice.
The Medicare plan quality star rating system is a key factor in helping enrollees differentiate plans. The rating provides a one to five (actual results start at 2 stars) scoring system for Medicare Advantage Plans.6 The overall rating reflects treatment, preventive care, and customer satisfaction collected on the Medicare Advantage plan. Consumers who are interested in poring through more detail can find sub-ratings on the Medicare plan finder website7 and on HealthPocket’s Plan Details page for each Medicare Advantage plan.8
Researchers are finding evidence that the star ratings are beginning to move market share toward the higher rated plans.9 However, HealthPocket also wanted to see the effect a brand might have on Medicare Advantage market share. Because choices can be so numerous in the Medicare Advantage market, a consumer might fall back on a basic comfort level that a known and trusted brand can provide a good choice. Research also indicates that some older people select from among fewer choices based on brand awareness.10
UnitedHealth is the leading market share carrier for Medicare Advantage, with a reported market share of nearly 21 percent in February 2013.11 Humana has the second largest market share at nearly 17 percent. AARP branded plans are described on the AARP Member Advantages website12 as being structured the following way: “The AARP® MedicareComplete® plans are insured through UnitedHealthcare Insurance Company and its affiliated companies, a Medicare Advantage organization with a Medicare contract. UnitedHealthcare Insurance Company pays royalty fees to AARP for use of its intellectual property.”
Market share reports do not tend to break out AARP’s share from the rest of UnitedHealth’s, but a Congressional report in March 2011 stated that AARP branded plans then had an 11 percent market share and non-AARP branded UnitedHealth plans had an additional 7 percent market share.13
The chart below compares the average star ratings for AARP Medicare Advantage plan contracts with the remaining universe of Medicare plan contracts:
The data shows a significant oversupply of AARP contracts in the 3 and 3.5 range, while few AARP contracts reach 4 and none reach the excellent range of 4.5 and 5. In fact, only 8.5% of AARP plan contracts exceed 3.5 stars. Averaging all contracts with ratings excluding AARP, the average score equaled 3.47, while the average for the AARP contracts equaled 3.27.
The highest scoring plans across their average contract scores were nonprofit health plans, including Kaiser (7.9 percent market share, but still an average contract score of 4.93), Gundersen Lutheran Health System, Baystate Health and HealthPartners Inc.) However, for profit plans also had higher average contract scores than AARP, such as Humana (3.4) and Aetna (3.65.)
HealthPocket also looked at how the branded AARP Medicare Advantage plans fared compared with the industry in how the plans were rated by a survey of their members. The chart below shows how the AARP plans compared with the remainder of the plans in the industry with respect to members who rated the plan highly.
The industry average for all plans excluding AARP for this response was 86 percent of members rated the plan highly, while AARP’s plan contract average was 83 percent. Perhaps more importantly, the AARP plans top out at 86 percent, while the rest of the industry has 62 plan contracts at 90 percent or higher and tops out at 95 percent.
A lot of factors drive consumers’ decisions regarding their health plan purchase. They will be heavily motivated by cost, including premiums, copays, deductibles and maximum out-of-pocket expenses. Many will want to make sure that key physicians participate in their plan and that specific health care facilities are in a plan’s network. Therefore, quality should play one important role in a mix that contains other factors.
At least with respect to Medicare Advantage quality scores and consumer satisfaction data, the AARP branded plans are not top performers. Yet they are successful in achieving strong market participation.
Fortunately for consumers CMS, the Medicare plans’ regulator, has done an excellent job of releasing data to the public and on its own plan finder website. This allows easier comparison of plans and brings plan quality into the mix for consumer decision making. Being able to see actual ratings and customer satisfaction might provide enrollees sufficient peace of mind to look beyond the brand in determining health plan selection.
Data on attrition, complaints and star ratings were taken from 2013 CMS Medicare Part C Performance Data tabulations.14 The data was based on contract numbers, which can represent multiple plans. UnitedHealth contract numbers were compared against Medicare Advantage plan landscape data to determine which UnitedHealth plans carried the AARP brand. Medicare Advantage contract plans that were either too new or had insufficient data to a have star rating or overall plan rating were eliminated from this review. The remaining plans were not adjusted for market share.15 This study did not consider premium costs or other plan details.
All analysis assumes the accuracy of the underlying government data. While every effort was made towards a representative collection of plans, HealthPocket makes no representation that every plan within the Medicare Advantage market was included in this study. Percentages are rounded according to standard industry practices.
Steve Zaleznick, Executive Director for Consumer Strategy and Development at HealthPocket.com, completed this survey analysis. Correspondence regarding this study can be directed to Mr. Zaleznick at email@example.com. Feedback and questions are welcome but, given the volume of email, personal responses may not be feasible.
1 Kaiser Family Foundation report: http://kff.org/medicare/issue-brief/medicare-advantage-2013-spotlight-enrollment-market-update/
2 Research from AHIP: http://www.ahip.org/TrendsMedigap2012PDF/
3 Particularly relevant to this report is Chapter 10 of Nudge, a book by Richard Thaler and Cass Sunstein, which reviews decision making at the onset of the Medicare Part D program
4 See Health Affairs article: http://content.healthaffairs.org/content/early/2011/08/16/hlthaff.2011.0132.abstract
5 A similar rating system applies to Part D prescription drug plans
7 See this example
8 See Journal of American Medical Association: http://jama.jamanetwork.com/article.aspx?articleid=1557733
9 See: “The Impact of Age on Brand Choice,” Chapter 9 of The Aging Consumer: Perspectives From Psychology and Economics
12 UnitedHealth suggested in an administrative proceeding that some plans with a high concentration of special needs populations could affect their overall scores. See this Hearing Officer Decision.
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