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By Thomas Goldsmith and Anne Blythe

Advocates for older people contend that the online method many people and advisers use to select Medicare plans has gotten so difficult to navigate that beneficiaries will run into trouble trying to make their choices.

Federal Medicare representatives maintain there’s real benefit to consumers in changes the agency has made following a critical assessment of the Medicare Plan Finder website by the U.S. Government Accountability Office. Also, national and state officials said, any change of method is hard given the highly complicated public and private health care landscape.

Among those questioning the redesigned finder are Durham’s Senior PharmAssist, the North Carolina Coalition on Aging and national senior-health advocacy groups including the Medicare Rights Center and the Center for Medicare Advocacy. Under discussion is the already complicated web tool — called the Medicare Plan Finder — that beneficiaries and counselors use to select the best and least expensive plans for older people’s health care and prescription drug coverage.

Senior PharmAssist head Gina Upchurch. Photo credit: Satsuki “Sunshine” Scoville/ Senior PharmAssist

“People want standardization; they want to be able to understand and make informed choices,” said Gina Upchurch, executive director of Senior PharmAssist. The nonprofit helps beneficiaries choose prescription drug Medicare plan.

“If you keep adding more and more variables or moving parts, you have basically obliterated meaningful choice,” she said. “People are overwhelmed.”

‘They are listening’

The new software also introduces a new self-identification procedure that could open the door to unauthorized investigation of beneficiaries’ private medical records, said Upchurch, who’s been advocating for seniors for 25 years, since founding Senior PharmAssist in 1994, last year she won the North Carolina Institute of Medicine’s Award for Excellence in Health Policy Leadership.

Representatives of the federal Centers for Medicaid and Medicare Services and North Carolina’s Seniors’ Health Insurance Information Program (SHIIP) acknowledge a mixed response to the revised plan finder, but say the plan’s benefits outweigh its problems. SHIIP is a federally mandated service through which staff and volunteers help beneficiaries navigate the complexities of Medicare insurance plans.

State SHIIP director Melinda Munden said CMS told state senior-health agencies last month that previous functions such as determining the overall cost of a drug plan, absent in the new tool, should be reintroduced by the time Medicare’s open enrollment period begins Oct. 15.

“We are very grateful … with CMS’s response,” Munden said. “They are listening. And they are open to our feedback.

“It’s going to take us time. I think we can all exercise some patience and understanding.”

How can changes in software matter so much? For one thing, a significant chunk of North Carolina residents will use the finder plan. More than two million older North Carolinians and those with disabilities have coverage through Medicare, partly financed by lifetimes of payroll deductions. In the 2018 enrollment period, more than 90,000 people on Medicare received counseling from the state’s Seniors’ Health Insurance Information Program.

Private insurers favored?

Complaints have been “loudest,” Munden said, about the 2019 plan finder’s failure to identify a single annual cost for a prescription drug plan. Instead, beneficiaries would have to calculate variables such as a specific pharmacy’s price for a drug and the amount of the person’s copays and deductibles.

“They’ve taken something that worked very well and made it difficult to use,” Upchurch said.

Upchurch and members of national advocacy groups charge that the new plan finder seems to guide users toward Medicare Advantage plans. Medicare Advantage is coverage offered by private insurance companies that can offer a wraparound of health care plus prescription drug coverage and uses such perks as gym memberships to get users to sign on. While Medicare Advantage works well for some consumers, advocates say others may find unwelcome surprises in substantial copays, difficulty finding in-network physicians, and other differences from original Medicare.

What makes up Medicare?

Part A, which covers hospital inpatient care, hospice care, some home health care and some skilled nursing care — though not for long terms. Most people have paid for Part A throughout their lives with payroll deductions.

Part B, which covers doctor’s office care, outpatient care, physical and occupational therapy and some other services. Part B is available through a variety of insurance company offerings, which vary greatly in price, but by statute must cover the same services.

Part D, added during the presidency of George W Bush, covers prescription drug costs for Medicare beneficiaries. It’s also available through many different companies, which offer varying formularies, or lists of drugs, at a wide range of prices.

“The revisions … cater to Medicare private plans and those who sell them, rather than being in the best interest of Medicare beneficiaries, those who assist them, or in furtherance of an equitable Medicare program,” Judith Stein, executive director of the Center for Medicare Advocacy, said in a statement when the new plan was rolled out.

“CMS should rescind these changes, and should ensure that beneficiaries are not hindered by a delayed roll out of a completely new Plan Finder format, with no back-up system in place.”

The new Medicare plan finder software contains some positive changes as well as others that need revision, Munden countered. In any case, new and current beneficiaries can investigate, but not settle on, their choices with both the former and new plan finders until the end of September.

“The new Plan Finder is designed to be simple and intuitive for all users,” a CMS spokesperson in Atlanta told North Carolina Health News in an emailed response.

“Although change is always difficult, especially with something as widely known and used as the Plan Finder, CMS is confident that beneficiaries, SHIIP counselors and others will find it easy to learn and use.”

GAO panned old plan

The Centers for Medicare and Medicaid Services revised the tool extensively this summer after a July Government Accountability Office report said the Medicare Plan Finder, or MPF, is difficult to use and sometimes produces incorrect information.

“For example, MPF requires navigation through multiple pages before displaying plan details, lacks prominent instructions to help beneficiaries find information, and contains complex terms that make it difficult for beneficiaries to understand information,” the GAO report said.

The GAO report found that 73 percent of State Health Insurance Assistance Program directors said beneficiaries found the tool difficult to use, as did 18 percent of SHIIP counselors.

On August 27, CMS Administrator Seema Verma rolled out a redesign of the plan finder, citing President Donald Trump’s pledge to make Medicare stronger.

Another sticking point for advocates is a new process under which beneficiaries will have to set up a separate ID and password to gain access to their detailed Medicare records. And that means that someone working with the older person — an insurance broker, a relative or a volunteer for the NC Seniors’ Health Insurance Information Program — will also have a way to look at the beneficiary’s confidential information.

“I can go to Medicare.gov and start distributing your Medicare card to my neighbors,” Upchurch said hypothetically. “I can look at all of your medical claims.”

Munden said SHIIP counselors are expressly forbidden from looking up any beneficiaries’ private health information.

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Thomas Goldsmith

Thomas Goldsmith worked in daily newspapers for 33 years before joining North Carolina Health News. Goldsmith is a native Tar Heel who attended the UNC-Chapel Hill, and worked at newspapers in Tennessee...