Comparing In-Person versus Telephone Medicare Counseling: Beneficiary Satisfaction, Cost-Savings, and Plan Selection Decisions from 2014-2021.

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 versus telephone Medicare counseling on beneficiary satisfaction, cost-savings, and plan selection decisions.

Methods: Outcomes were assessed via anonymous post-counseling survey, including: 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 versus 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]) versus 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 versus telephone counseling recipients more often enrolled in or selected a new plan (46.5% vs 27.8%; p<0.05), while telephone versus in-person recipients were more frequently undecided (37.0% vs 24.4%; p<0.05). Overall satisfaction (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.