The Trump administration redesigned
the online Medicare Cost Finder for seniors to compare complex health insurance
options. But consumer advocates have identified instances when the tool has
malfunctioned and given inaccurate plan and price data.
by Akilah Johnson Nov. 25, 10:27 a.m. EST
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The
federal government recently redesigned a digital tool that helps seniors
navigate complicated Medicare choices, but consumer advocates say it’s
malfunctioning with alarming frequency, offering inaccurate cost estimates and
creating chaos in some states during the open enrollment period.
Diane
Omdahl, a Medicare consultant in Wisconsin, said she used the tool Friday to
research three prescription drug plans for a client. The comparison page, which
summarizes total costs, showed all but one of her client’s medications would be
covered. When Omdahl clicked on “plan details” to find out which medicine was
left out, the plan finder then said all of them were covered.
So she
started checking the plans’ websites, and it turns out there are two versions
of the same high blood pressure medication. One is covered. The other is not.
The difference in price: $2,700 a month.
In
Nebraska, miscalculations offered through the new Medicare Plan Finder were so
worrisome that the state in late October temporarily shut down a network of
about 350 volunteer Medicare advisers for a day because without the tool,
narrowing the numerous choices — more than 4,000 Medicare plans are available
nationwide — down to three top selections would be nearly impossible.
Days
later, EnvisionRxPlus, a prescription drug plan, sent an email to independent
insurance brokers nationwide recommending they not use the Medicare Plan Finder
because of incorrect estimates on drug prices and patient deductibles. (It’s a
warning they had yet to retract some two weeks later.)
Minnesota’s
Association of Area Agencies on Aging said in a news release on Nov. 14 that
the Medicare Plan Finder “continues to produce flawed results,” including
inaccurate premium estimates, incorrect prescription drug costs and inaccurate
costs with extra help subsidies.
More
than 60 million people use Medicare, which covers those over 65 and the
disabled. Users have to pick their plans annually. The current open enrollment
period ends Dec. 7. Medicare advisers — as well as advocates for seniors —
worry that the full weight of the tool’s inaccuracies will not be felt until
the 2020 coverage year begins and seniors head to pharmacies to fill
prescriptions or show up for medical appointments. For many Medicare
participants, selections made during open enrollment are irreversible.
“Millions
of people are going to be absolutely affected,” said Ann Kayrish, senior
program manager for Medicare at the National Council on Aging. “And you hate to
think about millions of people having the wrong plan. That’s kind of crazy.”
“It’s
not like there’s one consistent problem that you can fix and then be
addressed,” said David Lipschutz, associate director of the Center for Medicare
Advocacy. “It’s really like a game of whack-a-mole.”
The
Centers for Medicare and Medicaid Services, the government agency that
administers federal health programs, acknowledged in a statement that some
problems have been reported but said development of the redesigned tool, which
cost about $11 million, was an “iterative” process. The statement said CMS did
“extensive consumer testing … to ensure that the information that is displayed
is complete, streamlined, understandable, and is in plain language.”
CMS
said it previewed the new plan finder in June and began “road-testing” it in
July, saying “stakeholder feedback led to enhancements” that were implemented
before a public launch on Aug. 27. Updates have continued as users report
issues, according to the statement.
CMS
said this is the first time since the Medicare Plan Finder was developed in
2005 that the tool has been redesigned. The complete rebuild was necessary, it
said, because legacy technology and “proprietary software” couldn’t keep pace
with “the needs of today’s digital audience” and because the explosion in
options available to seniors under various plans.
Millions
of Medicare beneficiaries use the plan finder to reevaluate their insurance
choices during open enrollment. The tool drives traffic to Medicare.gov, where
users may filter, sort and compare choices. A recent Kaiser Family Foundation
analysis found that beneficiaries will have an average of 28 Medicare Advantage plans and 28 prescription drug plans to choose from in 2020. As
of Friday, there was no alert on the federal website warning of possible
inaccuracies because of the redesign.
Choosing
from myriad options can be so befuddling to the typical Medicare participant
that states offer help through the federally supported Senior Health Insurance
Program, which offers free one-on-one counseling to those eligible for
Medicare, their families and caregivers. In Nebraska, for example, seniors
choose from 30 Medicare Advantage and 29 Part D prescription drug plans, and
the plan finder tool offers a way to quickly sort through dense information.
“You
put in the drugs and you put in the pharmacies they want to go to, and it
prices them all out,” said Alicia Jones, administrator of the Senior Health
Insurance Information Program in the Nebraska Department of Insurance and chair
of the national SHIP Steering Committee. Without the plan finder, she said,
“the only way to do that is go to 29 different websites and do them
individually.”
Some candidates use
Medicare-for-all to establish themselves as bold progressives or moderate
pragmatists. The Trump administration uses it as a point of attack. But voters
don’t know what it actually means, and none of the candidates explain it.
Jones
said she has flagged about 100 errors with the new tool since Oct. 1, some
small but others more significant. She noticed it wasn’t importing the correct
quantity of drugs, specifically with tubes of medication. It was, she said,
giving people way more medicine than needed, “so if you didn’t look at it
close, it would give very high prices.”
One
day, she said, the numbers for someone she was helping enroll in a prescription
drug plan were off by $2,000. The inconsistencies grew so worrisome that Jones
said they “just completely stopped” on Oct. 28 to better assess the situation.
Omdahl,
the Medicare consultant in Wisconsin, said it recently took her 32 clicks — she
counted — to return to the main page after trying to figure out what limits
apply for a specific Medicare Advantage plan’s referral and prior authorization
requirements.
Every
day, each of the 21 Senior LinkAge Line specialists working with Metropolitan
Area Agency on Aging, serving the Minneapolis-St. Paul area, have come across
at least one error, said Hannah Fox, a Senior LinkAge Line specialist.
“The
inaccuracies we’re seeing and are concerned about have to do with the
medication copays,” Fox said. “The plan finder is telling us that a medication
is on a plan formulary — or not on the plan formulary — and, again, we’re
contacting the plan and getting the reverse.”
Julie
Roles, spokeswoman for the Minnesota agency, said “specialists know what to be
looking for, so they can ID something that might be wrong. But an ordinary
person who is just looking by themselves really won’t be alerted to an issue.”
The
agency advised beneficiaries who have already enrolled in a plan to verify
pricing and other details with the plan provider. It’s also asking CMS “to
immediately remedy this situation and to extend the open enrollment period for
at least three months once the Plan Finder tool is fixed.”
In New
York, Judith Esterquest said she had previously grown so frustrated using the
tool to reevaluate her Medicare options that she gave up. This year, she tried
again, finding a prescription drug plan that would save her money. Then she
decided to double-check with a friend who also happens to be a SHIP adviser,
asking, “Am I reading this right?”
“I’m an
educated person. I have a PhD. I should be able to figure it out,” she said,
adding that she spent “an enormous amount of time” on the National Institutes
of Health’s website looking at research protocols when her husband was
diagnosed with a rare form of leukemia. “I am comfortable with technology, and
I had trouble with the Medicare website.”
According
to federal documents used during a national Medicare education meeting, more
than 20 million users visited Medicare.gov to use the plan finder in 2017,
accounting for about a third of all traffic to the site.
“Plan
Finder users often find the process daunting,” the documents said. “Research
has shown that users want Plan Finder to provide the following: Simpler results
- only information they really need to make a good decision; Personalized
information - based on their individual situation. Clarity on out-of-pocket
costs.”
The
U.S. Government Accountability Office laid out a number of issues with the old
plan finder in a July report, including “cumbersome” navigation,
confusing instructions, difficult filter and sort functions, and incomplete
cost estimates for traditional Medicare that makes it difficult to compare with
Medicare Advantage.
“So
many of these systems are held together by baling wire and chewing gum,” said
Lisa Bari, an independent consultant who previously worked on health IT,
interoperability and artificial intelligence at CMS’ innovation center.
The
contract for completely redesigning the Medicare Plan Finder was awarded to the
software design and engineering company Ad Hoc, which describes itself as being
born from “the successful effort to rescue HealthCare.gov after its disastrous
initial launch.” The federal online insurance marketplace, a major component of
the Affordable Care Act, crashed within hours of launching in 2013, and
additional technical problems kept it from functioning properly for weeks.
In a July 2018 blog post, Greg Gershman, Ad Hoc’s chief
executive officer and co-founder, announced that his company had won the
contract for developing a replacement plan finder as part of the Medicare
Coverage Tools initiative. He said “Ad Hoc proposed a product development
process that centers around understanding beneficiaries desires when trying to
make care decisions, tests our understanding early and often via a minimum
viable product, and adds value to the experience with iterative product
enhancements.”
Gershman
did not respond to requests for comment.
Bari,
who did not work on the project, said the issues described to her suggest
logic, calculation and coding errors that stem from poor user acceptance
testing. That kind of testing, typically the final phase before new software is
released, ensures the software can handle real-world tasks and perform up to
development specifications. It can be difficult, she said, to find enough
people with the necessary skills to do appropriate testing with something as
complex as drug coverage.
With a
large-scale project that will be used by millions, such as the Medicare Plan
Finder, there should be about a month of testing to identify problems, fix them
and get everything signed off on, Bari said. Each cohort of features, she
added, should go through this process.
“It
sounds like they’re just patching stuff now,” she said, “trying to catch the
holes that weren’t caught or specified.”
Derek
Willis contributed to this report.
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