Beneficiary knowledge of the Medicare program.

Introduction

The Medicare Current Beneficiary Survey (MCBS) is a powerful tool for analyzing the Medicare population. Based on a stratified random sample, we can derive information about the health care use, expenditure, and financing of Medicare's 36 million enrollees. We can also learn about those enrollees' health status, living arrangements, sources of and need for information, and access to and satisfaction with care.

Figures 1, 2, and 3 examine non-institutionalized beneficiaries' assessment of their knowledge of Medicare and compare their self-assessment with their knowledge of specific aspects of the program. In May-August 1997 we asked beneficiaries to assess their knowledge of the Medicare program. We asked beneficiaries if they felt they knew “… just about everything they needed to know, most of what they needed to know, some of what they needed to know, a little of what they needed to know, or almost none of what they needed to know” about various aspects of the Medicare program. We asked whether beneficiaries knew about: covered medical services, how much they have to pay for covered medical services, supplemental or medigap insurance—such as what it covers or how it works with Medicare to pay medical claims—the availability and benefits of Medicare health maintenance organizations (HMOs), finding a doctor or other health care provider, and staying healthy.

Figure 1

Beneficiaries Self-Assessment of How Much They Know About Several Key Medicare Topics: 1997

Figure 2

Percent of Beneficiaries Who Answered Several Basic Medicare Questions Correctly, by Their Self Reported Knowledge of the Medicare Program: 1997

Figure 3

Percent of Beneficiaries Who Answered “Not Sure” to Several Basic Medicare Questions, by Their Self Reported Knowledge of the Medicare Program: 1997

We also asked beneficiaries five true/false questions about the Medicare program. We asked them to respond true, false, or not sure to the following statements: “Medicare pays for flu shots;” “Medicare pays for a mammogram every 2 years;” “Medicare pays for an annual physical examination;” “A doctor who accepts assignment can't charge more than Medicare allows for covered services;” and “If you don't agree with a decision Medicare makes on a claim from a doctor or hospital, such as whether it will cover the service or how much it will pay, you can appeal the decision.”

Findings

The results show that most beneficiaries are confident of their knowledge in finding or choosing a doctor and staying healthy, with 63 percent and 76 percent of beneficiaries, respectively, stating that they know all or most of what they need to know about these topics (Figure 1). More than one-half of beneficiaries, however, feel that they know little or none of what they need to know about the availability and benefits of Medicare HMOs. This correlates with earlier studies showing that as many as 40 percent of Medicare beneficiaries had never heard of Medicare HMOs. On the topics of knowledge of the Medicare program, such as what services are covered, how much beneficiaries must pay for covered services, and supplemental or medigap insurance, beneficiaries were split—40-50 percent believe they know most or all of what they need to know while 30-40 percent believe they know little or none of what they need to know.

Beneficiaries' self-assessment of their knowledge of the Medicare program and other health care issues appeared to be accurate when judged by their responses to the true/false questions about the Medicare program. The group of beneficiaries who stated that they knew all or most of what they needed to know about the Medicare program consistently had a larger percentage of correct responses to the true/false questions than beneficiaries who believed they knew little or none of what they needed to know about the program (Figure 2). The group of beneficiaries who stated they knew little or none of what they needed to know about the Medicare program had a large percentage of “not sure” answers to the true/false questions (Figure 3).

Conclusion

This data from the MCBS seems to indicate that Medicare beneficiaries are confident in their knowledge of personal health issues such as staying healthy and choosing a doctor. Beneficiaries also are fairly knowledgeable about some aspects of Medicare fee-for-service such as what services are covered, how much they must pay for the services, and their rights to appeal Medicare decisions on claims. The majority of beneficiaries, though, feel they do not have enough information concerning Medicare HMOs. The new information campaign, which began in fall 1998, should address these concerns for the beneficiaries by offering them detailed information on Medicare HMOs and other managed care options available to them.