Medicare Coming of Agers Enrollment Journey Mapping Study

Theoretical Background and research questions/hypothesis:

Many Americans have little visibility into the Medicare enrollment process until they are faced with decisions as they turn 65. This is exacerbated by a growing trend of individuals delaying retirement until after 65, further complicating the decisions they have to make. Many coming-of-agers (CoAs; people within three months of turning 65) and Late Retirees (people who have delayed retirement until after 65) are surprised to learn that there are multiple decisions they have to make to get the right health coverage for their retirement. The Centers for Medicare and Medicaid Services (CMS) conducted a study to document the Medicare enrollment decision-making process and identify touchpoints at which CMS can more effectively reach out to CoAs and Late Retirees.

Methods:

We conducted a multi-method study that included longitudinal and cross sectional approaches. Twenty-two CoAs and Late Retirees participated in the longitudinal portion of the study during which they participated in: (1) an initial in-home interview; (2) six online diary entries over 3 months that depict where they were in their journey and their emotional states; and (3) a final phone follow up interview focused on how they made their final decision(s). We also conducted cross-sectional interviews and/or focus groups with 16 coming of agers and new enrollees, and with 25 Medicare enrollment stakeholders (i.e., human resources representatives, health insurance brokers, SHIPS, and Medicare customer service representatives) to get a holistic view of the enrollment process from various perspectives. Together, these data have been consolidated into a comprehensive Medicare enrollment journey map and clustered into personas of the different ways that CoAs and Late Retirees approach the decision making process.

Results:

Participants had a mental model of Medicare being one program that they were automatically enrolled in when they turned 65. Many participants were not collecting social security prior to 65, so they did not receive official communications regarding Medicare as they initially expected. Instead, as they got closer to 65 they started receiving large amounts of mail and phone calls from a variety of sources (e.g., insurance brokers), and they often could not differentiate the credibility of various sources. Participants were also not initially aware of the various decisions they had to make (e.g., picking a way to get their Medicare coverage, picking specific plans within that coverage type) and felt unready, overwhelmed and concerned about making the wrong decision. Participants varied in whether they took a proactive or more reactive approach, their feelings towards the process, and their level of risk tolerance. We identified four different decision-making persona types: “the seeker”; “the analyst”; “the disorganized contemplator”; and “the avoider.”

Conclusions:

This study identified challenges that CoAs and Late Retirees face during their Medicare enrollment journey, and also highlighted various touchpoints where CMS could potentially improve outreach and education strategies to help alleviate some of the common challenges.

Implications for research and/or practice:

The Medicare enrollment journey map and associated personas resulting from this research will be key in translating the findings from this study into actionable insights that can inform the development of communications strategy and resources.