The Centers for Medicare and Medicaid Services
(CMS) redesigned the Medicare Plan Finder to address many concerns. Probably,
the best summary of these concerns is in the July 2019 GAO report, “Medicare Plan Finder: Usability
Problems and Incomplete Information Create Challenges for Beneficiaries
Comparing Coverage Options.”
Let’s take a look at some of the GAO’s
comments and see whether the new Plan Finder actually fixes anything.
“One of
these stakeholders also told us that MPF (Medicare Plan
Finder) navigation is cumbersome because users cannot jump directly to
certain pages or sections that address their needs, such as viewing the
availability of preferred pharmacies.”
GAO
Report
In the current or Legacy Plan Finder, some
users find it difficult to view preferred pharmacies,
those that offer preferred retail cost sharing. That won’t be a problem with
the new Plan Finder. It doesn’t include preferred
pharmacies.
As for navigation, a header bar on each page
of the Legacy Plan Finder allows you to click and go back. For instance, you
want to change pharmacies. Click on the link and land on the pharmacy page. The
only way I found to go to previous pages in the new Plan Finder is to hit the back button. More
than once, I backed myself right out of the system.
“… in our interviews two stakeholders also noted that navigation
is difficult because beneficiaries are uncertain of the information needed to
make different comparisons or identify specific plans. For example, the ability
to filter and sort plan information does not appear until later in the plan
search process, where users are refining plan results.” GAO
Report
In the Legacy Plan Finder, the ability to
filter and sort plans appears after entering medications and pharmacies. There
are three separate categories: Part D drug plans, Medicare Advantage plans with
drug coverage, and Advantage plans without drug coverage.
In the new Plan Finder, you can choose Part D
drug plans or Medicare Advantage plans at the beginning and there is a link on
some pages to see all the drug or Advantage plans. However, the sort filter is
problematic. There are four sort items for Medicare Advantage plans and
three for Part D drug plans, compared to 10 and eight, respectively, in
the Legacy Plan Finder.
The default in the new Plan Finder is lowest
monthly premium. Change that to lowest estimated costs (which does not include
the premium), look at plans, return to the first page and the search goes back
to lowest monthly premium.
Another concern is the comingling of Medicare
Advantage plans with and without drug coverage. Once you’ve selected Medicare
Advantage, you see all the plans. Because the default sort is lowest monthly
premium, many plans without drug coverage appear first. It’s possible a
beneficiary could select one of those, without realizing the difference. And,
if choosing one, there is no alert that she or he could face a late enrollment
penalty for Part D. (The Legacy Plan Finder separates these two types of
plans.)
“As part of the redesign, CMS is also taking steps to provide
more complete cost information in MPF to help compare coverage options,
according to agency officials.” GAO Report
As for interpreting how much they will pay for
drug coverage, the new Plan Finder does not
include an estimate of total costs for the year. For whatever
reason, it includes only the out-of-pocket costs, not the premiums.
“Some
stakeholders noted that beneficiaries do not always understand terminology,
such as the differences between cost sharing, copayment, and out-of-pocket
costs. Most stakeholders also noted that beneficiaries struggle to understand
cost estimates and interpret how much they will have to pay.”
GAO
Report
Unfortunately, terms such as out-of-pocket
max, copayment, deductible, etc., identify the costs a beneficiary will face
and are part of the landscape. The new Plan Finder does include these terms
because there is no simple substitute.
“According to CMS, in order to ensure user and stakeholder needs
are met, the redesigned MPF tool will be rolled out in phases. During a
public preview phase, scheduled for early August 2019, users can access the
redesigned MPF, but can opt out at any time to use the legacy MPF. During this
phase, CMS plans to route subsets of users to the redesigned MPF with the goal
of routing 100 percent of users to the redesigned MPF by
mid-August (actually late August). The full launch, scheduled for October
1, 2019, will route all users to the redesigned MPF, and they will no longer
use the legacy MPF.” GAO Report
This is one of the most troubling aspects of the
new Medicare Plan Finder: the timeline for implementation. CMS is giving
everyone who does plan reviews just one month to test the system. And, this
isn’t just any month. It’s the month before the biggest plan review time of the
year, Open Enrollment. No more practicing then.
“A 2017 CMS study noted that MPF navigation is difficult and is
better suited for specialist users who assist beneficiaries in determining
their coverage options.” GAO Report
By its very nature, Medicare plan review is
very complex and complicated. I don’t believe there’s much that can be done to
change that. In its quest to make this a beneficiary “do-it-yourself” system,
however, CMS is eliminating many of the tools that
help to find the best plan, the ultimate end result. Consequently,
beneficiaries will likely experience cost and coverage issues in 2020. That
should scare the 45 million who are enrolled in a Part D drug plan and the 22
million who have Medicare Advantage plans.
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