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New Research Finds Many Seniors Wrongly Think Public Health Insurance Exchanges Are Replacing Medicare Plans

ST. LOUIS, Sept. 17, 2013 /PRNewswire/ -- As the nation approaches open enrollment for new public health insurance exchanges and Medicare, a new survey shows major misconceptions among seniors over how healthcare reform impacts Medicare benefits. This knowledge gap, coupled with fear about the affordability of healthcare, could lead seniors to make poor Medicare enrollment and health decisions.


Fifty States of Confusion, a new national survey of those age 65 and older finds that one-in-five seniors mistakenly thinks they can enroll in a medical and prescription drug plan through a health insurance exchange, even though the eligibility age ends at 65. Another 17 percent believe health exchanges could replace their Medicare plan altogether.  

While seniors may not be clear about Medicare and the Affordable Care Act (ACA), they are convinced their healthcare dollars must be better managed. The survey revealed nearly half of seniors are making changes to ensure they can afford their healthcare costs. Of the 46 percent who are making changes: 78 percent are adjusting their budgets, and 40 percent are considering temporary employment. However, 20 percent are skipping doctor's appointments, 18 percent are delaying medication refills, and 14 percent are skipping medication doses — all poor choices that could cause more harm.

"The conflicting chatter about healthcare reform has seniors confused about what actions they need to take this fall and concerned about their finances," said Rebecca Rabbitt, PharmD, Vice President, Government Programs at Express Scripts. "We need to close this knowledge gap so seniors can make informed decisions about their health and their Medicare benefits."

In August 2013, Express Scripts (NASDAQ: ESRX) commissioned Kelton, a research consultancy, to survey 1,101 seniors currently enrolled in a Medicare plan or who will be Medicare eligible within the next twelve months.

Eighty-six percent of survey respondents reported confusion about how healthcare reform will affect their Medicare prescription drug coverage. Among the notable misconceptions:

  • Nearly one-third of seniors (29 percent) believe the ACA raises the Medicare eligibility age, with 68 being the average age cited;
  • 52 percent falsely believe they're paying more for their prescription drugs in the Coverage Gap under healthcare reform; and
  • 65 percent do not know that Medicare enrollment begins in October.

Not only are seniors unclear about what's to come, many are uninformed about the changes healthcare reform has already had on the Medicare prescription drug program (Medicare Part D). Seventy-seven percent did not know that the Coverage Gap (or Donut Hole) is in the process of closing as a result of healthcare reform — a significant modification that substantially reduces a senior's out-of-pocket drug costs. 

"Many seniors are delaying refills and skipping doses to save money without realizing that, since 2010, Part D beneficiaries on average saved more than $1,000 when the Affordable Care Act began to lower the out-of-pocket maximum in the Coverage Gap," continued Rabbitt. "Their poor decisions could actually increase their healthcare costs, and more importantly, could affect their health."

Less than half (46%) of respondents feel knowledgeable about reform, but nearly all (89 percent) said they need access to more information about how healthcare reform will affect Medicare. To help seniors make better decisions, Express Scripts is offering a free eGuide, "Navigating Medicare: A Roadmap for Seniors and Caregivers" available at Seniors can learn more about the Affordable Care Act, its impact on Medicare, and how to choose a Medicare Part D benefit that is right for them.

About Express Scripts

Express Scripts manages more than a billion prescriptions each year for tens of millions of patients. On behalf of our clients — employers, health plans, unions and government health programs — we make the use of prescription drugs safer and more affordable. Express Scripts uniquely combines three capabilities — behavioral sciences, clinical specialization and actionable data — to create Health Decision Sciencesm, our innovative approach to help individuals make the best drug choices, pharmacy choices and health choices. Better decisions mean healthier outcomes.

Headquartered in St. Louis, Express Scripts provides integrated pharmacy-benefit management services, including network-pharmacy claims processing, home delivery, specialty benefit management, benefit-design consultation, drug-utilization review, formulary management, and medical and drug data analysis services. The company also distributes a full range of biopharmaceutical products and provides extensive cost-management and patient-care services.

For more information, visit or follow @ExpressScripts on Twitter.

Jennifer Luddy

David Myers

SOURCE Express Scripts
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