Critics
say tool can cause confusion by obscuring out-of-pocket costs
By RICARDO ALONSO-ZALDIVAR of the Associated
Press Nov 22, 2019
WASHINGTON
— Medicare’s revamped prescription plan finder can steer unwitting seniors to
coverage that costs much more than they need to pay, according to people who
help with sign-ups, as well as program experts.
Serving
about 60 million Medicare recipients, the plan finder is the most commonly used
tool on Medicare.gov
and just got its first major update in a decade. The Trump administration has
hailed the new version and Medicare Administrator Seema Verma said it will
empower beneficiaries to take advantage of their coverage options.
But as
open enrollment goes into the home stretch Thanksgiving week, critics said the
new tool can create confusion by obscuring out-of-pocket costs that seniors
should factor into their decisions.
“I want
to make sure people are given the most accurate information and they’re making
the best decision — because they are the ones stuck with it,” said Ann Kayrish,
senior program manager for Medicare at the National Council on Aging, a
nonpartisan organization that advocates for seniors and provides community
services.
Government
programs mixing health care and technology have faced struggles. Despite
billions spent to subsidize electronic medical records, getting different
systems to communicate remains a challenge. The Obama administration’s launch
of HealthCare.gov
resulted in an embarrassing debacle when the website froze up the first day.
The
leading Democrat on the Senate Aging Committee said he’s hearing concerns from
constituents and organizations that assist Medicare beneficiaries. Pennsylvania
Sen. Bob Casey said he will ask Medicare to grant seniors who’ve had problems a
second chance to sign up, called a “special enrollment period.”
“It’s
obviously an effort that needs a lot more work to meet the legitimate
expectations of seniors,” said Casey. “Especially when you launch something
new, (it) can go awry. People steered in the wrong direction should get a
measure of fairness.”
The
Medicare plan finder’s issue stems from a significant change the agency made
for 2020.
The
plan with the lowest premium now gets automatically placed on top, with the
monthly premium displayed in large font.
Medicare’s
previous plan finder automatically sorted plans by total cost, not just
premiums.
But
premiums are only one piece of information.
When
out-of-pocket expenses such as copays are factored in, the plan with the lowest
total annual cost is often not the first one shown by the plan finder.
It
takes extra work for a Medicare enrollee to discover that.
“If
they pick the plan based solely on the premium they are likely getting a plan
that could cost them thousands more in a calendar year,” said Christina Reeg of
the Ohio Department of Insurance. She heads a program that helps Medicare
enrollees try to find the right plan.
In a
statement, Medicare said the monthly premium is a cost that consumers
understand and will always be an important decision factor.
But the
agency also said total cost paid out-of-pocket is at least equally, if not more
important, particularly for people who take prescription drugs — as do most
seniors. Medicare said it’s testing ways to encourage consumers to look at
total costs, such as a pop-up.
The
agency said it chose to prominently display premiums because user testing
showed that’s what consumers are familiar with. The total annual cost is
included, but in smaller font.
That’s
puzzling to Kayrish. The lowest premium “doesn’t necessarily translate to
lowest cost over the year,” she explained.
Consumers
using the plan finder first enter their medications and dosages. To get it to
find plans by lowest total annual cost, they must take a few more steps, said
Kayrish.
After
the screen displays initial search results, consumers should look for the
drop-down menu on the right of the screen. Next, she said, select the feature
that lets you re-sort plans by “lowest drug + premium cost.”
A
reporter’s sample search on a list of six medications for high blood pressure,
high cholesterol and diabetes returned 29 plans in the Washington, D.C., area,
topped by a lowest-premium option for $13.20 a month.
But
after re-sorting for the lowest total cost, the best deal was a plan with a
monthly premium of $25.80.
When
out-of-pocket expenses were factored in, the second plan cost about $5,800 less
a year than the initial lowest-premium option the plan finder displayed.
Costs
can vary so much because plans have different coverage designs and they don’t
pay the same prices to drugmakers.
And
Kayrish said there’s another issue: The new plan finder can return options that
don’t cover all of a patient’s medications.
If a
low-premium plan has very high out-of-pocket costs, it’s a clue that some of
your drugs may not be covered. Check plan details.
Some
academic experts compared the old and new versions of the Medicare plan finder
and confirmed the problems flagged by hands-on users.
Their
review also found improvements. Among them:
Consumers
can enter their Medicare number and the new plan finder automatically fills in
all the medications the program paid for. (Consumer advocates recommend
double-checking this list.)
The new
tool can be used more easily on mobile devices and tablets.
The
revamped plan finder allows consumers to compare across Part D drug plans and
Medicare Advantage medical plans.
“The
new plan finder is in many ways improved, but it did take a meaningful step
backward by not doing more to highlight its most useful output— the total cost
estimate,” said Brian McGarry, an assistant professor at the University of
Rochester in New York. He’s the lead author of a recent online article about
the plan finder for Health Affairs.
Seniors
have until Dec. 7 to pick or switch “Part D” prescription drug plans or, if
they’re seeking comprehensive medical care through a private insurer, a
Medicare Advantage plan. Coverage takes effect Jan. 1.
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