Your Weekly Medicare Consumer Advocacy Update
How Beneficiaries Choose Medicare Plans
New Study Details How Seniors Choose Medicare Plans
A recent Kaiser Family Foundation (KFF) study investigated how seniors make their Medicare plan choices. With the increase in plan options over the past 20 years, and the rise in the popularity of the Medicare Advantage program, the plan options for Medicare beneficiaries have become increasingly difficult to navigate. The study involved multiple focus groups held in four cities across the US. Overall, the study found that, while beneficiaries like having a choice in Medicare plans, most feel they lack the tools and the knowledge to choose the works best for them.
The study also detailed a few specific themes about how seniors make their Medicare plan choices. First, while costs and networks factored in when a beneficiary was making their initial Medicare plan decisions, familiarity with the plan name and a positive experience with the plan representative were also key decision factors. Second, beneficiaries find the wealth of information on plans that come from multiple sources (i.e. mail, radio, television, internet, etc.) to be overwhelming and difficult to organize in a meaningful way. Unfortunately, seniors found Medicare.gov’s Plan Finder to be difficult to use. When they needed help making a decision, many relied on insurance agents, friends, family, doctors’ offices, or pharmacists to give them advice.
For these reasons, few Medicare beneficiaries reassess their options and make plan changes during the Fall Open Enrollment period, which is the time of the year that Medicare beneficiaries are allowed to switch their plans. Many respondents stated that they would only change their plan if their costs rose significantly, if their doctor was no longer in the network, or if their drugs were no longer covered.
The study concluded that, in order for seniors to make meaningful choices between Medicare plans, the available information needs to be better organized and presented in a way that is easy to understand. If this is not done, Medicare beneficiaries will continue to stay in plans simply because switching is too difficult for them to do. This often results in higher costs than are necessary, both for the beneficiary and for Medicare.
Medicare Rights Center Outlines Ways to Enhance Medicare’s Plan Finder Tool
To assist the Centers for Medicare & Medicaid Services (CMS) in their efforts to continuously improve the Medicare Plan Finder tool, the Medicare Rights Center submitted a memo last week, outlining various ways the tool can be enhanced as an important resource for beneficiaries.
During the 2013 Fall Open Enrollment period, Medicare Rights’ national helpline fielded 2,200 calls, many related to Part C and Part D enrollment. Of these, the helpline counselors directly assisted more than 100 beneficiaries and family caregivers with Part D plan comparisons and other in-depth assistance using Plan Finder. Medicare Rights recommended the following enhancements compiled from the experiences of those helped on the helpline:
1. Improve pricing detail accuracy and clarity for Extra Help beneficiaries::
- Correct the cost information for beneficiaries losing deemed status
- State whether a drug plan is enhanced or basic
2. Adopt more personalized drug plan comparisons::
- Utilize a tiered sorting function
- Allow beneficiaries to input personalized and specific dosage information
- Leverage claims data in the personal drug list
- Provide cost and coverage information to enrollees in sanctioned plans
3. Improve pharmacy network information::
- Ensure access to a rich and robust database of pharmacies
- Add a mechanism by which one can request the addition of a local pharmacy
- Streamline the display of preferred versus non-preferred pharmacies
4. Enhance the comparison report::
- Juxtapose quantity limit information with the medication and dosage list
- Account for visual impairments
- Display cost information specific to the coverage phases the beneficiary will reach
- Display cost information specific to each drug according to where it is received
5. Investigate the accuracy of plan pricing and coverage data:
- Ensure data is aligned with information provided directly by Part D plans
Medicare Rights concluded, “We appreciate CMS’ ongoing commitment to updating and improving Plan Finder. We are grateful for the availability of this robust tool, which is critical to our efforts to assist beneficiaries, family caregivers and other professionals with the annual process of reevaluating a person’s prescription drug coverage.”
Volume 5, Issue 20
Medicare Advantage (MA) plans and Original Medicare differ in four key ways:
- Providers you can use. Depending on the type of MA plan you have, you will generally have less or no coverage if you go out of the plan’s network to receive care. Original Medicare will cover your care from most doctors and hospitals in the country.
- Benefits. MA plans must offer all the benefits available under Original Medicare, and most also offer Medicare prescription drug coverage (Part D). Some MA plans may offer additional benefits that Original Medicare does not cover, such as dental care or eye care. If you have Original Medicare, you need to purchase a stand-alone Part D plan for drug coverage.
- Premium. In Original Medicare, you pay only the Part B premium. MA plans may charge a monthly premium in addition to the Medicare Part B premium.
- Out-of-pocket costs. With Original Medicare you generally pay 20 percent coinsurance for doctors’ and other medical services. Some people purchase an additional plan to help cover the 20 percent, called a Medigap plan. MA plans usually have fixed amounts for services (copayments). Depending on the service, this copayment may be higher or lower than what you would pay under Original Medicare.
Last week, Kaiser Health News (KHN) and NPR ran a story about Walter Bianco, an Arizona man who was denied access to an expensive drug treatment for Hepatitis C. Mr. Bianco, whose health has precipitously declined due to his condition, appealed the denial of his prescribed drug treatment, which involved a combination of two costly prescriptions, Sovaldi and Olysio. The denial was upheld by Mr. Bianco’s Part D plan because the Food and Drug Administration (FDA) has not yet approved the combined usage of the drugs.
In a recent development, KHN reported that Medicare overturned the denial of Mr. Bianco’s drug treatment. Medicare officials stated that the new policy will apply broadly to Hepatitis C patients who are prescribed the combined usage of Sovaldi and Olysio and have demonstrated “medical necessity” and have “medically accepted indications” for the treatment. Part D plans may approve or deny the drug treatment on a case-by-case basis. When the treatment is denied, Medicare Rights encourages beneficiaries to appeal the denial, particularly in light of Medicare’s recent stance.