Kristen Jordan Shamus, Detroit Free Press Published 6:00 a.m. ET Sept. 29, 2019 | Updated 12:08 p.m. ET
Sept. 29, 2019
A new online Medicare Plan Finder tool could make
it more time-consuming and difficult for seniors to research and
enroll in a Medicare prescription drug plan this year, advocates say.
"I have people on the margins," said
Julie Hine, a prescription analyst for the Senior Benefits Group,
which is a state-licensed independent insurance broker and works with
about 7,000 people each Medicare open enrollment period.
Some of them are seniors who are
homebound. Others don't have Internet access. She recalled one man
who makes his prescription drug list on the back of a
previously used envelope to save money on paper.
"That's perfectly good paper," she
said. These are people for whom every penny matters.
"Last year, we saved one person $14,728
by changing their prescription coverage," she said. "We have other
clients, you know, you save them $80 for the year and they're excited."
Hine is worried about some of the more
vulnerable seniors having to make impossible choices between food and
medicine because they might not be able to navigate the new Medicare Plan
Finder to make the best decisions about their prescription drug plans.
The Centers for Medicare & Medicaid
Services (CMS) first introduced the new system in late
August, and has been tweaking it since its introduction. The old system will be completely
shut down and replaced with the new Medicare Plan Finder on Oct. 1.
This change is happening two weeks
before Medicare open enrollment begins
Oct. 15. That's when millions of people ages 65 and older must choose
a prescription drug plan for 2020 before the enrollment window closes Dec. 7.
While many advocates agree that updates to the
old Medicare Plan Finder were needed, as it appears now, the new
system doesn't total monthly out-of-pocket costs to include co-pays and
deductibles. Users have to do the math on their own. It also doesn't have the
same sorting features as the old plan, making it more difficult to find
restrictions, see lowest-cost plans, sort and compare prices at pharmacies
that are preferred by the plan, Hine said.
In Michigan, about 20% of people, or 1 in 5, will
be faced with Medicare decisions this open enrollment period, said Jo
Murphy, who is executive director of the Michigan
Medicare/Medicaid Assistance Program, which contracts with the
state's 16 Area Agencies on Aging to
help Michigan's seniors navigate the Medicare system.
It's tedious and
complex work because each possibility is complicated by whether
the person uses mail-order, in-network, or out-of-network pharmacies,
drugs that are not on a particular plan's formulary, preferred and generic vs. brand
name medications, deductibles, co-pays and more.
"Details matter," Murphy said.
"They cost people money, and this is people's health care that we're
talking about. We save the residents of Michigan millions of dollars every year
in money that they would have had to pay because they didn't know the right decision
to make or they didn't get help getting a problem straightened out."
Hine agreed, adding: "Every time someone
goes into a nursing home that uses a long-term care pharmacy, somebody needs to
do an evaluation to make certain that the long-term care pharmacy is an
in-network pharmacy for the plan that's selected. Otherwise, the family's
paying out of pocket for the medication.
"Who is advocating for these people?
We are."
It's people like Hine and State
Health Insurance Counseling & Assistance Program (SHIP) counselors who work
for Murphy's nonprofit program and other senior advocacy
groups who are losing sleep over the changes the new Medicare Plan
Finder that might make their work harder, and could force them to turn away
seniors who need help this year because they just couldn't get to everyone
within the open enrollment period.
That's why the National
Council on Aging and others are urging seniors to call to
schedule appointments with a Medicare counselor early to ensure they get the
help they need.
"Don't wait," said Ann Kayrish,
senior program manager for Medicare at the National Council on Aging.
For seniors who opt to enroll on their
own using the Medicare Plan Finder themselves, she urged them to
allow plenty of time to use the new website, learn how it works early in the
the open enrollment period, so if problems arise, there's still time to get
help.
The population eligible for Medicare
is generally less tech-savvy than younger Americans and also less
connected, the Pew Research Center said
in a 2017 report about tech adoption among older adults.
One-third of adults ages 65 and older said
that they never use the Internet. About half said they don't have home
broadband Internet service, and the proportion of seniors who own smartphones
is 42 percentage points lower than those ages 18-64 who said they do.
And among the seniors who do have Internet
service, Pew reported: "Some 34% of older Internet users say they
have little to no confidence in their ability to use electronic devices to
perform online tasks, while 48% of seniors say that this statement describes
them very well: 'When I get a new electronic device, I usually need someone
else to set it up or show me how to use it.' "
If seniors feel overwhelmed trying to
use the new system, don't have Internet access or have questions or
concerns, Kayrish said they should call a Medicare counselor in October to get
an appointment early in the Oct. 15-Dec. 7 open-enrollment period.
"Those that use SHIP counselors, get
your appointment earlier than later," she said. "There's only so much
time during open enrollment. And because each appointment is
going to take longer, there is a chance some people won't be
seen."
Murphy said she's encouraged to see that CMS
has been taking concerns of the counselors who work with seniors seriously, and
has been updating the new plan finder continuously since late August.
"It was designed for the general
public," she said. "It's much cleaner. But in the whole design
process, some of the things that were there before got lost. This is what
happens when you change systems.
"In fact, as we're speaking, it's not
finished. ... We gave feedback, and suggested some changes, and they made those
changes.
"We keep submitting complaints. We
can submit it every day, and I have nearly every day seen changes. So
they are continually working on it. There are some bigger things that are
important, and they have prioritized those."
For example, Murphy said CMS has given
assurances that the function that shows total monthly out-of-pocket costs
for each prescription drug plan will be added to the system by Oct. 1.
"We are all waiting anxiously for Oct.
1," she said. "At this point, I know every little thing people
may want there will not be there, but I am feeling comfortable the little
things that are really important will be there. I can log on every day and
it will be different."
But that adds to the difficulty in training
her staff. She wishes there had been more time to smooth out the
bumps.
"It's been a very difficult
transition, partially because it's been a late rollout," Murphy said. "I
have 700 people in the state of Michigan who need to be trained.
I would have liked to have been able to start that training earlier. And
even today, we have to say here's what we know right now because it's
continuing to change."
And that makes the timing of this change
especially problematic.
"Buckle up," said David Lipschutz,
associate director of the Center for Medicare Advocacy. "The
fact that very little time was given for counselors to test, troubleshoot and
get used to the new plan finder prior to open enrollment,
which starts on Oct. 15," is going to make for a rocky
transition.
There won't be overlap of the old and new
Medicare Plan Finder systems during the Oct. 15-Dec. 7 open-enrollment
window, either, Lipschutz said. On Oct. 1, the old system will disappear.
"This update seems to be motivated, in
large part, by a change in federal contractor," he said. "There's one
federal contractor that has the old plan with a contract that's expiring next
week. So on Oct. 1, a new contractor takes over."
Some of the functionality of the old system
will be lost when that happens, such as the ability to save a list of
prescription drug plans that has been tailored to an individual's
medications without having to use personally identifying
information, such as a Medicare number. Instead, every senior will need to
create a My Medicare account to
save a drug list.
For seniors without home Internet access or
smartphones, Hine said, this could be a problem because many of them have
no clue how to create a My Medicare account, and don't even have a
valid email address to link to such an account.
These challenges will make it more
time-consuming for counselors who work on behalf of large numbers of
seniors to help them narrow down the Medicare prescription drug plans that are
going to be the most cost-effective, said Casey Schwarz, senior
counsel, education & federal policy for the Medicare
Rights Center, a national, nonprofit consumer service
organization.
"The burden on these folks (high-volume
users) was not well considered and not well planned-out and that is a
problem," she said. "We want to be really clear that the
inability to save an anonymized search and not be able to go back to it has a
real impact on high-volume users and will create a situation where they
can help fewer people. That's a real problem. I don't want to minimize that ...
but the burden is not going to be a burden to an individual user.
"I think CMS did some good beta testing.
The decision tree aspect of it, the way questions appear one at a time, all of
those things are actually much easier for people who have never done this or
who have only done this once or twice.
"But because this is a departure from
what people have known, people who may have developed their own shortcuts and
ways around the clunkiness ... someone who has used the old system is going to
find this more confusing than someone who doesn't use the old system."
Lipschutz said his organization is concerned
that the new plan finder's requirement to use a My Medicare account to
save a drug list gives too much personal health data to third-party
counselors, some of whom could use their private health information for
unscrupulous things.
"This tool that's
being touted by agents and brokers to securely import data
directly from the Medicare.gov website, including prescriptions filled,
pharmacies used, and health care providers utilized, there's significant
concern that such information could be abused, and that could be used to either
steer people toward or away from certain plans. These issues CMS
has not addressed adequately, in our view.
"As added kind of backdrop, these changes
to the Medicare Plan Finder are happening at a time when there are some
pretty significant changes on the Medicare policy level that go into
effect in 2020. And that includes the expansion of what Medicare Advantage
plans can provide with respect to supplemental benefits."
Sherrill Heinrichs, 71, of Bloomfield
Township, said it's unsettling.
She works in congregational care at
Northbrook Presbyterian Church in Beverly Hills, where she helps members with
various life challenges — whether they're young, old or in between.
Heinrichs was looking at the new Medicare Plan
Finder earlier this week and was baffled by some of the
changes.
"Some medications have been deleted, and
some are going up in price," said Heinrichs. "I ran into a problem
right away with one of my meds, which is an antibiotic because I had
double knee replacement. I have to have antibiotic whenever I need dental work.
I need four amoxicillin three times a year. There is no way to put it in
the site. You have to do one pill a month for 12 months. It
doesn't accept what I need.
"It's frustrating and it's like anything
else, it might be easier for some people to do but for our
seniors, we need help."
Heinrich said she had lunch recently with many
of the older congregants at her church and warned them to get started soon
on choosing a new plan.
"I explained to them what is going on and
that they needed to be very careful if they went online," Heinrichs
said. "With the old plan finder, you could do it by yourself and it
works. The new one, it doesn't seem to work right, and it doesn't give you the
same options that you had before.
"It's very hard. Why they are making it
more complicated for seniors, I don't know. ... If people
don't know where to go for help, they really are stuck. They
are going to be paying a lot more."
Heinrichs said she called her local Area
Agency on Aging-1B to set up an appointment with a Medicare counselor to figure
out what's best for her, but her appointment isn't until
November.
Hine said that for older men and women who've
been working with her company for years, there's a feeling of personal
responsibility to ensure they're getting a prescription plan that fits their
needs.
"They call us when
their spouse had surgery and they get invoices that they don't
understand," she said. "We help them look at their Medicare summary
notices to figure out what's allowable and what needs to be re-billed or any
time they have an issue there.
"They're coming to us. I'm just concerned
about Delores and Gertrude and Beatrice — all the names
that are gone from the kindergarten rolls.
"My heart is breaking for our
seniors."
Contact Kristen Jordan Shamus: 313-222-5997 or
kshamus@freepress.com. Follow her on Twitter @kristenshamus.
How to get Medicare help
To speak to a Medicare counselor through
the State Health Insurance Assistance Program, call 800-803-7174.
The new Medicare Plan Finder can be found
online at https://www.medicare.gov/.
Tips for this year's Medicare open enrollment
Open enrollment runs Oct. 15-Dec. 7 to choose
your 2020 Medicare health plans.
Advocates recommend that anyone enrolling
in a Medicare prescription drug plan should:
·
Check out the new
online Medicare Plan Finder early. It will replace the old website on Oct. 1.
You can find it at: https://www.medicare.gov/
·
Create a My Medicare
account at https://www.mymedicare.gov/.
·
If you have trouble or
need help, call Medicare's 24-hour helpline toll-free at 800-Medicare
(800-633-4227).
·
If you need help
comparing plans and enrolling, you also can call a free counselor at the State
Health Insurance Assistance Program at 800-333-4144. Or call an established
Medicare insurance agent. It's best to schedule an appointment now
for later in the month or November. Advocates urge seniors not to wait
until December to make an appointment.
·
Give yourself time to
really think about what prescription drug plan best fits what you need.
·
Keep in mind that just
because a prescription drug plan worked great for you in the
past doesn't mean it's the best plan for you in 2020. Most plans have
changed what they will offer in the year ahead.
·
Resist the urge to be
lured by a low premium alone. The best plan is one that covers the drugs
you take without restrictions like prior authorizations or quantity limits,
that could impair your access to your medicine.
·
Check out the
formulary on the website of each plan you're considering. You'll really
have to dig into the plan details to determine whether the drugs you take
are covered by each plan, know the restrictions, step therapy,
quantity limits.
·
The change is going to
require more effort. Be sure you're designating more time during open
enrollment to be confident that you're picking the plan that's right for
you.
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