Team member Christina Wu interviewing a recent Medicare enrollee.
This is Part 2 of a blog series chronicling the team’s experience improving Medicare enrollment process. Part 1 (team and problem introduction) can be accessed here: Blog 1
Tina is 67 years old and is beaming as she tells us about her new baby grandson. Family and health are on her mind. She tells us how she enrolled in Medicare two years ago on her 65th birthday. She had nervously been anticipating Medicare enrollment since she was in her early 60’s and quickly became overwhelmed with the volume of complicated information she needed to sift through to enroll. “These are big and important decisions and if you don’t have help deciphering it, then you could make a wrong decision that impacts you the rest of your life.”
Based on what Tina said, our team wanted to better understand how people feel about these big and important decisions. Some feel lost. It’s a Saturday morning when we speak with Jerry. He is looking forward to a relaxing weekend after a busy week at work. He just recently turned 65 years old and understands he needs to enroll in Medicare, but since he is still working and on his company’s private insurance plan he is not sure exactly what to do. “I don’t know who to call. Is there a government office? It’s confusing and scary because I don’t know what to do.”
Others feel equipped to confront the enrollment process. Patricia is 64 years old and preparing to enroll into Medicare. She loves spending time with her three grandchildren and spending her remaining free time gardening. She is planning to put in the minimum amount of time and understanding necessary to complete Medicare enrollment. Over the years, she has discovered the benefits to turning to professionals to help her in the administrative parts of her life (e.g. taxes, credit card bills, retirement planning), and is planning to outsource her decision-making in Medicare enrollment as well. “I just found an agent and he told me which plan to choose.”
And yet others take on the Medicare enrollment process in a DIY [do-it-yourself] style. Sam is 65 years old. He is tech savvy and even has a Bitmoji that quite resembles him. He just finished enrolling in Medicare. He recently received his red, white and blue card (Medicare health insurance ID card) in the mail and is looking forward to utilizing his Medicare benefits. He tackled the Medicare enrollment process head-on, relying on his own desk research and friends to navigate through important enrollment information. “[I] have enough friends who are older, so when it came to my turn, I knew what to do and where to go.”
Tina, Jerry, Patricia, and Sam are examples of individuals who engage with and approach Medicare enrollment in fundamentally different ways. These individuals underscore a common theme across Medicare enrollees: every individual has a unique context, emotional state, and approach to Medicare enrollment. Our team expected that individuals would likely approach Medicare enrollment in different ways; however, we did not expect such a high number of individuals would experience extreme confusion and stress over Medicare enrollment. The consequences of botching Medicare enrollment are real – users do not get access to the healthcare services they need and face lifetime financial penalties in the form of increased monthly premiums – which makes getting the Medicare enrollment process right critically important.
While the names listed above have been anonymized, these individuals are real people who represent wide swaths of Americans and their respective approaches to Medicare enrollment. As part of Harvard’s Tech and Innovation in Government field class, our team spoke with many individuals like Tina, Jerry, Patricia, and Sam as we engaged with Medicare enrollees to try and help the Social Security Administration and Centers for Medicare and Medicaid Services better adapt the Medicare enrollment experience for those aging into Medicare to focus on increasing simplicity, positive user experience, and clarity.
Understanding Medicare Enrollment
Before ideating on potential paths to increase simplicity, improve user experience, and promote clarity for Medicare enrollees, our team needed to understand Medicare enrollment from all angles. While we relied on desk research to get a sense of information Medicare enrollees might access online, we also engaged directly with enrollees, relevant government agencies, and Medicare enrollment stakeholders to supplement our research.
Enrollees – We spoke with 23 (and counting!) individuals who recently enrolled into Medicare, are currently enrolling into Medicare, or are about to enroll into Medicare to understand their experience. We leveraged our own networks and social media to recruit recent Medicare enrollees to interview. Of those we interviewed, the average age is 66 years, 63% are male, 65% hold an advanced degree, and 25% remain actively employed (which impacts how a user engages with Medicare enrollment at age 65). Interviews averaged 40 minutes in length, and we conducted interviews both in-person and over the phone depending on the geographic proximity of the interviewee to Boston. As we continue to interview enrollees, we are looking to expand our pool of interviewees to better reflect the diversity present in American society in terms of gender, race, and educational level. Our interview script allowed the interviewee to help us understand their mental state, feelings, approach, and knowledge of Medicare enrollment. We tried to keep our questions open-ended to allow the interviewee to share their unbiased thoughts on their end-to-end Medicare enrollment experience. Some of our questions asked the interviewee to draw out their Medicare journey, to describe the different parts of Medicare, and to share their emotional response to hearing “Medicare enrollment.”
Government Agencies (Centers for Medicare and Medicaid Services and the Social Security Administration) – Federal government agencies are responsible for administering the service of enrollment and compliance of the program once individuals are enrolled. We engaged directly with both of the aforementioned government agencies, having been introduced as part of the project. Each agency has deep knowledge and experience with Medicare and also provided the official word on how Medicare enrollment is expected to occur.
Stakeholders – The Medicare ecosystem is vast, ranging from healthcare providers to non-profits. Medicare stakeholders are critically important in the Medicare enrollment process by providing enrollees with information and guidance. Over a series of 10 interviews, we spoke with non-profits (including SHINE), insurance brokers, and healthcare providers to better understand how they support enrollees and their views on the current constraints of Medicare enrollment. Stakeholders are often more knowledgeable about enrollment than direct Medicare enrollees because they serve a specific function as related to enrollment. Speaking with stakeholders such as non-profits strengthened our team’s understanding of Medicare benefits. Similarly, many enrollees we interviewed indicated that they worked with non-profit counselors or insurance brokers while enrolling so we found the perspectives offered by these stakeholders critically important to understanding an enrollee’s Medicare journey.
What We Learned
Members of the team collating interview learnings.
After speaking with a range of key stakeholders and Medicare enrollees, we organized key user insights into four distinct stages of Medicare enrollment (Notification, Information Gathering, Enrollment, and Post-Enrollment):
Notification
64-year-olds that have not yet elected to receive SSA benefits are notified about Medicare through Social Security Statements, which are mailed out annually starting at the individual’s 60th birthday. Many interviewees were not aware that government notifies them about Medicare enrollment indicating that further notification efforts may be needed.
Private insurance companies bombard 64-year-olds with advertising that pushes enrollees towards their specific plans
Many enrollees find out they need to enroll via word-of-mouth
Information Gathering
Since Medicare has four different parts (Medicare Parts A, B, C, D) across two different channels (Original Medicare and Medicare Advantage), the naming convention for these areas creates confusion
Most people rely on non-governmental information sources ranging from private insurance companies to non-profit counselors
Intensity of research ranges widely depending on the enrollee
Enrollment
In assessing different Medicare plan options, enrollees look to optimize between minimizing costs and ensuring adequate coverage with existing, trusted health care providers
Technology comfort ranges across enrollees which impacts an individual’s ability to navigate the enrollment website
Post-Enrollment
Some issues with enrollment can only be addressed through mail
Some users are reluctant to use the online platform due to general online security concerns (driven by highly visible data breaches elsewhere) and site usability (many users found site resources to be overwhelming and/or have limited comfort access online resources/forms)
Some are hit with lifetime financial penalties due to unknowingly enrolling late
Next Steps
While we have learned a ton from our research to-date, we expect to continue engaging with both enrollees and stakeholders to keep building our knowledge base. We have also begun brainstorming as a team different ways to improve the Medicare enrollment process, grounding any ideas in learnings gleaned directly from users. For example, we are exploring how the Social Security Administration can better engage with future enrollees before they turn 65 years since notification (or lack thereof) from government was identified as a pain point. Additionally, since the majority of interviewees indicated substantial levels of confusion over Medicare enrollment, we are brainstorming ways to simplify and improve the information gathering phase of Medicare enrollment.
As we head into the final 6 weeks of the semester, we anticipate continuing to work with users as we test potential improvements and prototypes. We have already developed a long list of potential solutions for pain points identified by users and are refining these ideas in tandem with our client. These ideas will be prototyped, tested with users, and iterated upon before delivering a final solution / assessment to our clients at the end of the academic semester. We are excited to continue working with our clients and engaging end-users!
—Rob MacGregor, Gwendolyn Lee, Mia Li, Melia Henderson, Christina Wu