Why Digital and Health Literacy Are Critical for Medicare Advantage Success

In the United States, nearly 32.8 million people are enrolled in Medicare Advantage (MA), which now represents over half of all Medicare beneficiaries (KFF, 2023). This surge in enrollment brings heightened competition among plans, with each looking to differentiate through better outcomes, stronger member engagement, and higher Star Ratings. Amid these goals, digital and health literacy emerge as underappreciated, yet critical, factors that can significantly impact member satisfaction, plan retention, and healthcare disparities.

The Education–Retention Connection

• 43% of Older Adults Have Difficulty Understanding Health Materials
  According to a study by the National Assessment of Adult Literacy, nearly half of U.S. adults aged 65+ struggle to follow medical instructions or interpret insurance documents (NAAL, 2023). This confusion often drives higher call-center usage and dissatisfaction—two contributors to plan switching.
• 80% of Health Outcomes Tied to Engagement
  Research by various healthcare economists suggests that up to 80% of outcomes for chronic conditions depend on consistent follow-up and member engagement (HHS, 2022). High literacy levels translate to better medication adherence and preventive screening participation, which, in turn, reduce expensive hospitalizations by 15%–20% (McKinsey, 2020).
• Improved Star Ratings
  As member experience and outcomes weigh more heavily in the Star Ratings formula—now accounting for up to 57% of a plan’s overall score (CMS, 2023)—educating members on how to interpret benefits and use plan resources can lead directly to higher ratings. Plans with top Star Ratings see double-digit growth in enrollment and qualify for bonus payments worth millions of dollars (KFF, 2023).

GetSetUp tackles this front by providing live, interactive classes covering everything from reading Explanation of Benefits (EOBs) to understanding medication instructions. These sessions convert puzzled members into informed, proactive healthcare consumers—who are more likely to stick with a plan that meets their needs.

Tech Adoption: Closing the Gap and Cutting Costs

• $300 Billion in Avoidable Medical Spending
  The U.S. health system incurs up to $300 billion in unnecessary costs related to poor medication adherence and insufficient preventive measures (McKinsey, 2020). Telehealth, online portals, and digital monitoring can close many of these gaps—if seniors know how to use them.
• 35% of Medicare Beneficiaries Rarely Use Online Plan Tools
  A Kaiser Family Foundation analysis found that over one-third of seniors enrolled in MA rarely log on to digital portals or apps for basic tasks like finding in-network doctors or checking lab results (KFF, 2023). That translates to missed screenings, delayed treatments, and more costly interventions down the road.
• Telehealth Reduces ER Visits by 15%
  A multi-plan study by America’s Health Insurance Plans (AHIP) reported that older adults who consistently use telehealth services see a 15% drop in emergency room visits (AHIP, 2022). However, 47% of seniors surveyed said they remain uncomfortable scheduling telehealth without guidance (Pew Research, 2022).

GetSetUp connects older adults to practical digital skills—from booking telehealth appointments and managing health apps to navigating urgent care options online. When members can seamlessly adopt these tools, they cut down on costly emergencies and gain real-time control of their health decisions.

Social Determinants of Health (SDOH) and Health Equity

• 1 in 4 Seniors Lives in Social Isolation
  According to the AARP Public Policy Institute, social isolation contributes to $6.7 billion in additional Medicare spending annually (AARP, 2020). Coupled with digital illiteracy, these members are more likely to miss essential services and less likely to know about benefits like meal delivery or transportation support that many MA plans offer.
• 60%–80% of Health Outcomes Influenced by SDOH
  Multiple studies confirm that most health outcomes are driven by factors outside traditional clinical care (Robert Wood Johnson Foundation, 2021). If older adults don’t understand how to leverage MA plan resources—such as food assistance or fitness programs—they’re at higher risk for chronic disease complications.

Through targeted education, GetSetUp helps address SDOH barriers. Classes on internet basics, smartphone use, and online social groups provide older adults with access to the same wellness resources tech-savvy members enjoy. By bridging the digital divide, plans can significantly reduce disparities and empower at-risk populations.

From Confusion to Empowerment: Real Impact on Plans

Investing in digital and health literacy yields a substantial return for Medicare Advantage organizations:

• Higher Retention and Loyalty
  Members who are informed and feel confident in using plan resources are up to 40% less likely to switch plans during annual enrollment (JD Power, 2021).
• Boost in Preventive Care Uptake
  Health-literate members are more likely to schedule recommended screenings, improving outcomes and Star Ratings.
• Reduced Operational Costs
  Every 1% improvement in medication adherence can translate to millions of dollars in saved acute care costs annually for mid-to-large MA plans (Humana, 2021).

Meanwhile, overlooked gaps in digital or health literacy can lead to disenrollment, adverse events, and lower Star Ratings—ultimately harming both plan revenue and reputation.

The Next Steps for MA Plans

Digital and health literacy are no longer optional for Medicare Advantage success. They’re vital in today’s competitive landscape, where plans must excel in member experience, quality outcomes, and cost containment. By partnering with platforms like GetSetUp, MA plans can:

1. Empower members to understand and maximize their benefits.
2. Guide seniors toward telehealth, medication adherence, and wellness resources.
3. Narrow the digital divide, tackling key social determinants that drive up medical costs.

In doing so, MA plans not only meet rising CMS expectations and Star Rating thresholds but also foster healthier, more engaged members who stay loyal longer.

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