Comparing in-person versus telephone Medicare counseling: Beneficiary satisfaction, cost-savings, and plan selection decisions from 2014 to 2021

Abstract

Background

A pharmacy school and a State Health Insurance Assistance Program developed a Medicare plan selection assistance program in 2013. In 2020, the program changed from in-person to telephone counseling.

Objective

To compare the impact of in-person vs. telephone Medicare counseling on beneficiary satisfaction, cost-savings, and plan selection decisions.

Methods

Outcomes were assessed via anonymous postcounseling survey, including the following: 1) program satisfaction (4-items); 2) annual cost-savings (2-items); and 3) plan selection decisions (1-item). Beneficiary satisfaction was measured using a Likert-type scale (1 = strongly disagree, 5 = strongly agree). Projected cost-savings was calculated as the difference between the total annual drug plus premium costs of the patient's current vs. newly selected plan (actual costs-savings) or least expensive plan option (potential cost-savings) for the next benefit year. Plan selection decision was measured via multiple-choice with response categories of “enrolled in or selected a new plan,” “undecided,” or “stayed with their current plan.” Differences in mean satisfaction scale scores, cost-savings, and plan selection decisions between in-person (2014–2019) and telephone counseling (2020–2021) were analyzed using Mann–Whitney U and Fisher's Exact tests. Predictors of plan selection decision were assessed via logistic regression.

Results

Beneficiaries (N = 632; in-person n = 564; telephone n = 68) were mostly female (59.8%), White (52.1%), and 69 years on average. The overall mean [SD] satisfaction scale score was higher among recipients of in-person (4.55[0.575]) vs. telephone counseling (4.30[0.645]; P = 0.002), but there was no statistically significant difference in mean projected annual cost-savings. Further, in-person vs. telephone counseling recipients more often enrolled in or selected a new plan (46.5% vs. 27.8%; P < 0.05), while telephone vs. in-person recipients were more frequently undecided (37.0% vs. 24.4%; P < 0.05). Overall satisfaction (adjusted odds ratio [aOR] = 11.548; P = 0.009) and potential cost-savings (aOR = 1.001; P = 0.020) predicted selection of a new plan.

Conclusion

In-person counseling resulted in a greater proportion of beneficiaries selecting a new plan whereas telephone counseling resulted in greater decision inertia.