Medicare enrollment continues to pose challenges for beneficiaries, but there are concrete steps that policymakers can take to reduce the burden according to Better Medicare Alliance.
October 08, 2020 - Beneficiaries suffer from
chronic confusion over Medicare enrollment but policymakers can take action to
streamline the process and improve beneficiary experience, Better Medicare
Alliance asserted in a recent white paper.
“The limitations of our current Medicare enrollment process
do a disservice to our nation’s seniors, too often leaving new entrants
uncertain and unable to make decisions that would benefit their health and
well-being,” Allyson Y. Schwartz, president and chief executive officer of the
Better Medicare Alliance, said in the press
release.
“Even as changes have been made to improve the information
available to beneficiaries, confusion and difficulty remain. With over 10,000
people turning 65 years every day in our country, we can do better.”
A 2019 study commissioned by Better Medicare Alliance found
that nearly half of all Original Medicare beneficiaries were unaware that
Medicare Advantage plans existed.
Meanwhile, well over a third of Medicare beneficiaries (37
percent) are confused by Medicare enrollment support resources, a
separate survey by
GoHealth found. Ahead of the 2021 Medicare open enrollment
season, respondents indicated that health literacy and cost would present major
barriers for enrollees.
Better Medicare Alliance outlined five evergreen challenges
that beneficiaries face and five ways that HHS, CMS, and policymakers on
Capitol Hill can improve the Medicare enrollment process.
CHALLENGES OF MEDICARE ENROLLMENT
Better Medicare Alliance identified five challenges for
Medicare beneficiaries around enrollment.
First, there is no single government entity in charge of
enrollment. Instead, beneficiaries receive communications from numerous
unassociated entities. Furthermore, the enrollment process takes place via the
Social Security Administration instead of CMS, which experts said seems like a
more natural option.
Second, beneficiaries can accrue penalties for not making a
decision within the timeline or for choosing the wrong health plan.
Third, beneficiaries have a strict window of seven months
around their 65th birthday to select their plan, which can lead to a rushed
decision.
Fourth, comparing health plans remains challenging. Although
CMS tried to fix its
Medicare Plan Finder website to make it more navigable, some have criticized
the updated site as presenting similar problems as the previous version’s.
Fifth, beneficiaries continue to suffer from a lack of
personalized education on their health plan options. Navigators are
available but cannot recommend specific plans and sufficiency of navigator
training varies by state. The Medicare & You booklet that
CMS issues each year to cover Medicare plan options is not tailored; the handbook for
2021 spans 124 pages.
FIVE POLICY RECOMMENDATIONS TO
IMPROVE MEDICARE ENROLLMENT
To address these enrollment concerns, Better Medicare
Alliance offered five policy recommendations ahead of open enrollment for plan
year 2021.
HHS should take over Medicare enrollment, the organization
recommended, with the enrollment process designated specifically to CMS. Thus,
education materials and enrollment processes would be within the same agency
and department.
Better Medicare Alliance also stressed having Medicare
subject matter experts available locally. CMS should employ the Administration
for Community Living to oversee the State Health Insurance Assistance Program
(SHIP).
The second policy recommendation addressed updating the
educational resources for potential enrollees. Organizations and businesses
that offer Medicare guidance but are unaffiliated with CMS should be subject to
a review to ensure that their information is correct.
“Enforcement actions should be increased for those that
misrepresent Medicare’s brand and information,” the white paper added.
Additionally, the Medicare & You handbook
needs to be updated with input from a diverse set of Medicare beneficiaries as
well as beneficiary advocacy groups regarding what information and format would
be most useful for enrollees.
In its fourth policy recommendation, Better Medicare
Alliance pushed for the beneficiary engagement process for Medicare enrollment
to begin earlier, at the age of 64. This would require a Congressional move to
officially extend the timeline, giving beneficiaries more than seven months to
consider their options.
Finally, CMS needs to continue to hone its Medicare Plan
Finder tool. The next update should include filters that allow beneficiaries to
search by out-of-pocket costs, provider network, supplemental benefits, chronic
disease management or other condition-specific programs, and Star Ratings.
“The tool should enable individuals transitioning from
Medicaid or private coverage to more easily find coverage options based on
their preferences regarding continuity of care and care delivery model, such as
integrated care,” the white paper added. “The tool should also be available to
caregivers, family members, or others authorized to assist the beneficiary in
exploring options. Searches should be able to be saved and returned to by the
beneficiary or designee.”
As with the Medicare & You handbook
update, beneficiaries should be integrally involved in the process of revising
this tool.
“Systemic solutions and reforms such as those recommended in
this report are critical to ensure that all Medicare beneficiaries have timely,
trusted, complete and clear information about their enrollment options and
confidence that they can make the coverage choice that will best meet their
health and financial needs,” the white paper emphasized.
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