Are you a health care worker? We’d love to hear from you. Email editor at northcarolinahealthnews.org
By Thomas Goldsmith
A newly revised Medicare sign-up page can produce drastically inflated costs for some drugs, incorrect premiums for low-income people, and other “worrisome” results, say North Carolina health officials who work to make sure people over 65 get appropriate benefits.
Top management at the federal Centers for Medicare and Medicaid Services, known as CMS, promised this year that a revised Medicare Plan Finder would make it easier for beneficiaries to choose their 2020 coverage under the federal health insurance plan.
Users found an initial revamp lacking this year and more glitches are emerging as the Trump administration pushes beneficiaries to sign up for Medicare Advantage coverage. These privately run Medicare plans often require more complicated user calculations.
About a third of Medicare beneficiaries have chosen Medicare Advantage plans, sometimes trading perks such as gym membership for more comprehensive long-range coverage available under the original Medicare program.
“The Medicare Advantage component … delivers efficient and value-based care through choice and private competition, and has improved aspects of the Medicare program that previously failed seniors,” Trump wrote in an executive order this month that announced protections and improvements for Medicare.
CMS has said that beneficiaries will benefit from increased high-quality options for Medicare Advantage and prescription drug plans. In addition, consumers were supposed to benefit from the “modernized and redesigned” plan finder first rolled out in August.
Online problems persist
However, with Medicare’s open enrollment period underway since Oct. 15 and lasting until Dec. 7, the overhaul has generated significant problems, according to officials at the North Carolina Seniors’ Health Insurance Information Program, known as SHIIP. Some streamlined changes have proved effective, but people in at least two situations are having real trouble getting answers through the Medicare Plan Finder website.
One issue has arisen for people of low income and limited means who are eligible for “extra help” under the program. “Those costs are not being accurately reflected in the plan finder,” statewide SHIIP director Melinda Munden said.
Another problem has come up for beneficiaries whose prescriptions include multiple items such as insulin pens in one package.
“They’re packaged five to a box,” said Jo Paul, senior technical adviser at SHIIP. “Today I had a lady who gets two boxes a month and it wanted to charge her for 10 boxes.”
In another example, an ointment tube meant to contain 60 applications instead produced a charge for 60 tubes.
Munden and other people involved in Medicare sign-ups said they have notified CMS in Atlanta about the problems this week, but haven’t received help. CMS has issued guidance including a Q&A on problems with the plan finder.
‘A little bit worrisome’
It’s troubling to people who work in the field that consumers trying to arrange vital health-care details online may not recognizes glitches in the software that could have major effects on their costs and coverage for the coming year. Even for the trained staff at the Durham nonprofit agency Senior PharmAssist, it’s taking longer to complete an enrollment, director Gina Upchurch said. The agency has not yet called in its 17 experienced volunteers to work with consumers because the staff wants to make sure they have different eventualities covered.
“All we have done this week is find ways to work around the obvious ways of doing things,” Upchurch said.
In another glitch, beneficiaries who enter their recently introduced new Medicare numbers see their form automatically repopulated with their Social Security number. The idea of the new numbers was to remove Social Security numbers from the process, Upchurch said.
“That’s a little bit worrisome, don’t you think?” Upchurch said.
The plan finder is supposed to let beneficiaries compare costs between Medicare Advantage plans that could take the place of original Medicare hospitalization or Part A, a Medicare supplement for doctor’s care or Part B, and a Medicare Part D prescription drug plan. That means that it’s crucial that the prices be accurate for each element and, for example, a Medicare Advantage overall plan.
“It gives you a total price, but it’s not particularly trustworthy,” Upchurch said.
Trump’s executive order encouraging Medicare Advantage begins with an extended condemnation of Medicare for All, a plan aimed at universal health care in different forms by several of his potential Democratic opponents in the 2020 presidential election.
Trump’s executive order proposes changes likely to be controversial in the overall Medicare program, including giving people the right to opt out of original Medicare, the fund to which most Americans have contributed throughout their working lives.
Under current regulations, those eligible for Medicare Part A must take it or forfeit their Social Security checks. The conservative Heritage Foundation has proposed allowing recipients to opt out of Medicare and to instead receive a subsidy for the health care plan of their choice.