Study: Medicare Advantage plans’ agents don’t paint full picture of options for beneficiaries

Most Medicare Advantage beneficiaries enroll with assistance from an agent, but this approach may not expose them to all available options, a new study shows.

Researchers at the Commonwealth Fund analyzed data from the Centers for Medicare & Medicaid Services as well as online search and brokerage data. They also interviewed industry experts and found that 96% of MA and Part D plans contract with agents.

However, online broker tools for beneficiaries often fail to show all available choices, the study found. In examining three major online tools across five markets, the researchers found that they included 43.3% of available MA plans and 64.7% of available Part D plans.

“Agents typically secure contracts with multiple carriers, but they are not required to contract with all available carriers in their market,” the researchers wrote. “This means that a single agent will not necessarily represent every available plan.”

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The study found that how many plans were excluded from the tools varied widely between regions, but all tools included in the study excluded at least some plans available to beneficiaries in that area.

Only one of the tools included in the study provided data on MediGap plans, the researchers found, and that included just 18% of such plans available across five counties.

Agents are not required to offer additional data about plans from insurers they do not contract with and may not provide complete and objective guidance about plans that are not from contracted carriers, the study found.

“We would instruct our staff in no uncertain terms that if they were using the tools and found a carrier that’s better for the client that we didn’t carry, just give them the toll-free number and tell them to call there,” a former brokerage manager told the study team.

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To address these challenges, the researchers suggest two key policy priorities: boosting transparency around and access to high-quality agents and offering greater support for organizations that educate beneficiaries beyond plan selection.

Agents should be incentivized to disclose which carriers they’re contracted with and any financial perks that may come with those contracts so beneficiaries can be sure they’re working with an agent that’s right for them, according to the study.

Continued investment in and other organizations that offer support and education to beneficiaries is also crucial, the researchers said.

“By taking a comprehensive look at the existing model, policymakers may conclude that strengthening regulations of the agent marketplace may not only help consumers make more effective choices but also serve the agents well by creating greater transparency and enabling high-performing agents to better distinguish themselves from their competitors,” they said.

“And finally, it may behoove policymakers to dig deeper and further understand the sources, nature, and types of information typically available to consumers, whether these resources meet the consumers’ needs, and whether a more comprehensive redesign of the Medicare guidance model is needed,” the researchers added.

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