The Digital Gap in Medicare Is Costing Plans More Than They Think

For the last decade, Medicare plans have invested heavily into portals, mobile apps, telehealth platforms, and digital engagement tools. In general, this seems like the right thing to do, but is it generating the ROI and member engagement that they are hoping for.

But a quieter reality is hiding behind those investments: many older adults still can’t confidently use the tools meant to help them. And that gap is costing plans - financially and competitively.

The Digital Confidence Gap

A recent GetSetUp survey of older adults makes the problem clear:

• Only about 29% of respondents said they feel “very confident” understanding their health benefits.
• Roughly 40% reported that they had never or only once or twice used their plan’s portal or app.
• Over 62% said they wanted more support understanding wellness or extra benefits like dental, gym, and transportation.

These aren’t “tech-resistant” members. They are willing participants in a system that hasn’t given them the support they need to succeed. And this pattern appears across national research.

The University of Michigan’s National Poll on Healthy Aging found that 78% of adults aged 50–80 have a patient portal.

KFF reports that 77% of adults 65+ have used a healthcare website or app.

Yet among portal users:

• Only 48% feel very confident understanding portal information.
• About 27% say training or a tutorial on portal use would be helpful.

In other words, older adults are online - but not fully engaged.

Digital Tools Without Confidence Are Expensive.

When members don’t understand how to use digital tools, the impact goes far beyond mild frustration.

According to Deloitte, 20–60% of member calls could be automated with better digital design and member training.

J.D. Power notes that shifting a customer service conversation from phone to digital can cut cost-to-serve by 50% or more.

Yet many health plans still carry growing customer service costs because members fall back to the phone whenever they hit a digital roadblock.

Clinical costs are affected too. Plans that successfully engage members in digital tools, especially when members log in frequently, see measurable improvements:

• 5–6% in overall healthcare savings, driven by better engagement and self-management.
• 17% fewer inpatient admissions, plus improved management of chronic conditions.
• Around $1,169 saved per member per year due to reduced hospitalizations in some digital-first programs.

Across multiple studies, one insight keeps surfacing: frequency matters more than intensity. Members who log in more often, even for short interactions, tend to generate the greatest health and cost benefits over time.

The Digital Member Experience Drives Loyalty

For Medicare plans, the digital experience is now directly tied to loyalty and Stars.

J.D. Power found that:

• 85% of members who rate their digital experience “excellent” say they intend to renew with their current plan.
• Only 39% of members with “poor” digital experiences say the same.

At the same time, roughly 21% of older adults have never used online tools, not because they don’t want to, but because they’ve never been shown how.

Combine that with the reality that up to 50% of MA members switch plans within five years, and it’s clear: poor digital onboarding isn’t just an inconvenience. It’s a retention risk.

Members rarely say, “I’m leaving because of your apps.” 

They say, “I’m confused,” “I don’t feel supported,” or “This plan is too hard to navigate.” 

Digital friction becomes a proxy for overall dissatisfaction.

The Solution Isn’t a Better Portal. It’s Better Activation.

Given all this, it’s tempting to assume the answer is another redesign, a new app, or more features. But the biggest opportunity isn’t more technology - it’s better activation.

That’s where GetSetUp comes in.

Instead of building yet another tool, GetSetUp partners with health plans to help older adults use the tools they already have. The model is grounded in:

• Live, peer-led onboarding and classes that feel safe, familiar, and relatable.
• 1-on-1 tutorials tailored to specific plan portals, apps, and workflows.
• Ongoing confidence-building, not one-and-done demonstrations.

Older adults learn best from people who look and sound like them, who understand their questions, and who move at their pace. That’s the heart of a peer-led digital activation strategy.

What’s at Stake for Plans

If just 1,000 more members become digitally activated, a Medicare Advantage plan has the potential to:

• Reduce churn by 10–15%, saving $600,000+ in retention and acquisition costs.
• Save around $125 PMPM in administrative and clinical spend.
• Boost satisfaction, improve Star Ratings, and reduce call volume.

And the member-level impact might be even more important: older adults who feel confident navigating their coverage are more likely to seek preventive care, use wellness benefits, and manage chronic conditions effectively.

Digital transformation is no longer just about building tools. It’s about building confidence.