How many Medicare beneficiaries have the knowledge they need about the Medicare program? How many get accurate information when they call Medicare?

In 2003, only about three of 10 disabled beneficiaries and four of 10 elderly beneficiaries said that they knew all or most of what they needed to know about the Medicare program. Only about six to seven of every 10 calls to the Medicare information line were answered completely and accurately in government audits conducted during 2004 and 2005.

Why is this important?

The Balanced Budget Act of 1997 required that the federal Centers for Medicare and Medicaid Services (CMS) educate Medicare beneficiaries to help them understand the Medicare program and their coverage options (Goldstein 2001).

• In response, CMS designed a National Medicare Education Program that uses multiple communication channels including printed materials, a toll-free telephone information line, Web sites, and training and support for information intermediaries such as state health insurance assistance programs.
• A reference handbook called Medicare & You was mailed to all Medicare beneficiary households in 1999 (following a five-state pilot in 1998) and continues to be mailed to all newly enrolled beneficiaries monthly.

Findings

Medicare beneficiary knowledge of the Medicare program has improved since the federal government enhanced its educational efforts in 1998, although less than one-half of beneficiaries say they knew all or most of what they needed to know. There was some retrenchment from 2001 to 2003 (CMS 2000, 2003, 2005a). Specifically:

• The proportion who said that they knew all or most of what they needed to know about Medicare increased by 8 percentage points from 1998 to 2001 (from 25 to 33 percent) among disabled beneficiaries under age 65, and by 10 to 11 percentage points (from 31–37 percent to 42–48 percent) among elderly beneficiaries ages 65 and older.
• From 2001 to 2003, this proportion decreased slightly (by 1 to 5 percentage points) but was still higher than in 1998. In contrast, most beneficiaries (94 percent of those who responded in 2003) said that they were satisfied with the availability of information about Medicare (data not shown).

Two audits conducted by the Government Accountability Office in 2004 and 2006 found that about three of every 10 calls that auditors made to the 1-800-MEDICARE beneficiary help line were not answered completely and accurately (GAO 2004, 2006). In the 2006 audit, the GAO also noted potential deficiencies in the readability or usability of written and Web-based educational materials and tools.

Implications

Most Medicare beneficiaries do not have what they consider to be an adequate knowledge of the Medicare program. The increase in the proportion who say they have adequate knowledge suggests that educational programs are having a small positive effect but have not greatly diminished the knowledge gap. Future research should determine the consequences of lack of knowledge of Medicare on beneficiaries' access to care and their health and financial outcomes.

Improvement Ideas and Resources

The GAO made a number of recommendations for CMS to improve the beneficiary call line, such as improving procedures, pretesting scripts, and increasing call monitoring. CMS has intensified its efforts to prepare beneficiaries for changes brought about by the Medicare Modernization Act of 2003 (CMS 2005b).

• The agency is partnering with Medicare consumer organizations and nonprofit community organizations that provide advice and counseling, focusing especially on low-income beneficiaries and their caregivers.
• A Regional Education About Choices in Health (REACH) campaign is providing culturally and linguistically appropriate information to those who may not receive information through traditional media channels.

Researchers suggest that CMS target future educational campaigns to vulnerable subpopulations, such as minorities and those with lower income and educational levels, who have lower levels of knowledge about Medicare (Uhrig et al. 2006).

Measure:

Self-perceived beneficiary knowledge was assessed by the following survey question: "How much do you think you know about the Medicare program?" The denominator is community-dwelling Medicare beneficiaries, stratified by age group. The numerator is the subset of the denominator population who answered "just about everything you need to know" or "most of what you need to know" on a five-point scale (CMS 2000, 2003, 2005a).

The 2004 and 2006 Government Accountability Office (GAO) audits were based on 420 and 500 calls, respectively, to the 1-800-MEDICARE beneficiary help line. Calls were randomly placed during July 2004 and during January and February 2006 to match typical calling patterns for the help line. For each call, auditors asked one of five (2006) or six (2004) questions selected from those addressed by the help line. Answers were considered inaccurate if they did not provide sufficient and complete information to meet criteria developed from the Medicare Web site's frequently asked questions section (2004) or from the prescription drug plan finder tool on the Medicare Web site, help line scripts, and input obtained from CMS officials (2006) (GAO 2004, 2006).

Limitations:

Although the survey question did not objectively assess beneficiary knowledge, other research found that self-perceived knowledge of Medicare correlated with objective measures of beneficiary knowledge: those who rated their knowledge of Medicare more highly answered more questions correctly on a seven-item knowledge quiz (Bann et al. 2003).

Source:

Beneficiary knowledge data were calculated by the Centers for Medicare and Medicaid Services from responses to the Medicare Current Beneficiary Survey, a "continuous, multipurpose survey of a representative national sample of the Medicare population" (CMS 2000, 2003, 2005a).

Audits of the 1-800-MEDICARE help line were conducted by the General Accountability Office, an independent, nonpartisan investigative arm of the U.S. Congress.

References:

* Indicates source of data used in the chart(s).

Bann, C. M., S. A. Terrell, L. A. McCormack et al. 2003. Measuring Beneficiary Knowledge of the Medicare Program: A Psychometric Analysis. Health Care Financing Review 24 (4): 111–25.

* CMS (Centers for Medicare and Medicaid Services). 2000. The Characteristics and Perceptions of the Medicare Population: Data from the 1998 Medicare Current Beneficiary Survey. Baltimore, Md.: U.S. Department of Health and Human Services.

* CMS (Centers for Medicare and Medicaid Services). 2003. The Characteristics and Perceptions of the Medicare Population: Data from the 2001 Medicare Current Beneficiary Survey. Baltimore, Md.: U.S. Department of Health and Human Services.

* CMS (Centers for Medicare and Medicaid Services). 2005a. The Characteristics and Perceptions of the Medicare Population: Data from the 2003 Medicare Current Beneficiary Survey. Baltimore, Md.: U.S. Department of Health and Human Services.

CMS (Centers for Medicare and Medicaid Services). 2005b. Unprecedented Beneficiary Support in Getting the Most Help from Medicare's Improved Coverage. CMS Medicare Reform Issue Papers 15.

* GAO (Government Accountability Office). 2004. Medicare: Accuracy of Responses from the 1-800-Medicare Help Line Should Be Improved. GAO-05-130. Washington, D.C.: Government Accountability Office.

* GAO (Government Accountability Office). 2006. Medicare: Communications to Beneficiaries on the Prescription Drug Benefit Could Be Improved. GAO 06-654. Washington, D.C.: Government Accountability Office.

Goldstein, E. 2001. CMS's Consumer Information Efforts. Health Care Financing Review 23 (1): 1–4.

Uhrig, J. D., C. M. Bann, L. A. McCormack et al. 2006. Beneficiary Knowledgeof Original Medicare and Medicare Managed Care. Medical Care 44 (11): 1020–9.