JustCare

Tag: Plan Finder

  • Don’t trust Medicare’s Open Enrollment information

    Don’t trust Medicare’s Open Enrollment information

    The Center for Medicare Advocacy reports that the Centers for Medicare and Medicaid Services (CMS) has not fixed many problems with the Medicare Plan Finder web site, and you still cannot trust information on the site during this Open Enrollment period. Problems were originally reported in August 2019, which you can read about here. For free assistance, contact your State Health Insurance assistance Program (SHIP) (1-800-677-1116) or the Medicare Rights Center at 800-333-4114.

    The Medicare site has three big problems. Much of the information on Medicare Advantage plans is misleading. It is still difficult to create a My Medicare Account. And, the Medicare Plan Finder still has inaccurate information about Medicare Part D prescription drug plans. You can’t find reliable information about drugs that are covered and their costs, drugs that are not on the formulary, dosage information, and copays for people who qualify for a Low-Income Subsidy.

    As a result, people are choosing Medicare plans based on inaccurate information. It is not yet clear how or whether people will be notified of the misinformation and whether they will have the option to change plans. The problems with Part D information are so bad that some companies offering Medicare Part D drug coverage have told its brokers and agents not to use the Plan Finder since it is not calculating people’s out-of-pocket drug costs correctly.

    The Center for Medicare Advocacy, Medicare Rights Center and Justice in Aging is requesting CMS to provide needed relief and protections to people who sign up for a Medicare plan based on misinformation so that they are not harmed by their decisions.

    They are also concerned that CMS is steering people into private Medicare plans without properly advising them of their risks or the benefits of traditional Medicare. Moreover, according to the National Association of Insurance Commissioners and others, the information comparing traditional Medicare with Medicare Advantage private plans is not complete. The biggest omission is in cost comparisons, which fails to reflect annual out-of-pocket costs that can be as high as $6,700 in Medicare Advantage plans.

    One of the biggest issues with private Medicare plans is that they are not standardized, costs and coverage are always changing and, even when information is accurate, it is impossible to know what treatments your plan will be cover and what you will pay. Delays and denials are common and out-of-pocket costs can be sky high. Traditional Medicare covers virtually all of the cost of your care from almost any doctor or hospital anywhere in the country so long as you have supplemental coverage. For that reason, it provides people who end up needing costly care with greater peace of mind. Unfortunately, supplemental coverage can be costly, depending upon where you live and your income.

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  • Medicare health plan website misleading at best 

    Medicare health plan website misleading at best 

    A large national organization that serves older adults recently issued a report critiquing Medicare’s Plan Finder website, which is designed to help people choose among Medicare health plan options. The website, which should provide helpful and reliable information is called out for being misleading and confusing. While fixes could improve the site, the lack of helpful information available about commercial Medicare Advantage plans dooms the site from the get-go.

    In its report, the National Council on Aging (NCOA) writes: “The site is overwhelming, information is poorly presented, and the user design is potentially misleading — all of which confuses beneficiaries and can contribute to many making poor plan selections.” As bad as the website is, even if it were improved, the Medicare Advantage health plan options cannot be compared in a meaningful way. For example, data about which plan delivers better value care for people with cancer, heart disease and stroke is unavailable.

    The Medicare Advantage plans do not reveal how they meet the needs of people with costly and complex conditions or out-of-pocket costs for people with different chronic conditions. Reliable data on Medicare Advantage plan performance and costs is sorely lacking. How good is the care available to people with congestive heart failure or diabetes? Medicare ratings of Medicare Advantage plans are a farce.

    Moreover, Medicare Advantage plans generally offer a limited choice of doctors, unreliable network directories, and no coverage outside of a person’s primary residence, except in emergencies. Choosing among Medicare Advantage plans is at best a poor gamble. Whichever plan you choose, you can save money if you need little or no health care. But, if your health needs are significant, you could be out of pocket thousands of dollars quickly or without needed health care.

    Medicare’s Plan Finder implicitly suggests that, with good information, people could choose a health plan that’s “right for them.” In reality, none of us know what our future health care needs will be or where in the US we will need care. Unless a health plan covers care from top specialists anywhere in the US—which none of the commercial Medicare Advantage plans appear to do—we are gambling with our care needs. Only traditional Medicare provides people with this important protection.

    With traditional Medicare, we are not forced to gamble with our health or our finances, though we do need supplemental coverage, which can cost $4,000 a year. The federal government should not be allowing older adults to gamble with their care, under the guise of suggesting that they can make an informed choice with the information provided on the Medicare Plan Finder site. At the very least, the feds should be ensuring access to a network of top physicians, with predictable costs, in the Medicare Advantage plans. In fact, it should guarantee everyone affordable coverage from a large network of providers throughout the US to meet their every need, through one government-administered health plan.

    Contrary to what the NCOA report suggests, it is not realistic to expect robust health plan competition in the Medicare marketplace or elsewhere, even if the Medicare Plan Finder were improved. So long as health plans are in the business of delivering profits to their shareholders, they will do everything in their power to provide information that deters people with costly and complex conditions from enrolling. And, they will limit access to specialists and/or impose high copays to encourage healthy members to disenroll when they become sick. That is not the kind of competition we want or need in our health care system.

    Aging, Schmaging, my new book, offers simple reliable advice on making Medicare choices, as well as Social Security, long-term care, housing, living wills, powers of attorney and more. If you make a contribution of $5 or more towards its publication in September 2018, you can get the first chapter–The Ten Should-Do’s for your Health Purse and Peace of Mind–now!

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