By Thomas Goldsmith
The state’s popular NC senior health insurance information program, or SHIIP, decided Monday to bring back online, state-compiled Medicare information that, until a change this year, consumers had used to choose among different Medigap plans.
It’s a reversal of a decision earlier this year when the state’s Department of Insurance, which runs SHIIP, had switched to a database created by a commercial vendor that has potential financial interest in the valuable health-care data that seniors enter into the system.
SHIIP is a nationwide program operated by each state to help Medicare beneficiaries navigate the confusing world of benefits, copays and insurance plans that get layered on top of the federally supported insurance. It’s a program that’s grown increasingly complicated over the past decade and a half, as prescription drug benefits, commercial Medicare Advantage options and a “donut hole” created by the rollout of the Medicare prescription benefit have been layered on top of the original coverage.
For years in North Carolina, SHIIP staff and county-based volunteers are trained to help seniors as they slog their way through multiple options. That often involves consultation of the state’s established database of choices for the crucial Medicare Supplement, or Medigap, coverage.
But earlier this year, the Department of Insurance opted for a database put together by CSG Actuarial, a Nebraska-based health-insurance data compiler. The change would have meant that SHIIP consumers would be relying solely on a new database from an outside vendor, reachable only through the sign-on of a SHIIP employee or volunteer.
SHIIP leadership said Monday that the new database has definite advantages and would create efficiencies, in part by taking the DOI workers who previously compiled the data and freeing them up for other tasks. They said it was recommended by the nonprofit SHIP National Technical Assistance Center, which works with similar agencies across the country.
North Carolinians who check on policies through the new database through SHIIP are being asked to provide age, ZIP code and other indicators, information that could be valuable in the multi-billion dollar U.S. health-care data industry.
Representatives of CSG Actuarial and the SHIP National Technical Assistance Center did not respond Monday or Tuesday to emailed questions about the use of data submitted to the company. SHIIP representatives said they did not know how beneficiaries’ data could be used under a federal grant to CSG through the SHIP National Technical Assistance Center.
In a statement on its website, CSG said it had had exponential growth in data compilation since starting as a product development consultant company.
“With a fine-tuned understanding of the insurance marketplace and a knack for building quality insurance products, the team began compiling premium Medicare Supplement rate data and transformed an enormous amount of data into an easy-to-use, unbiased online quoting tool,” the statement said.
Pros and cons
Those questioning this year’s new approach said it would make the work of helping older people harder by taking away their ability to research their own choices and requiring more back and forth communication by counselors.
Insurance professionals said the state had taken a system that was working reasonably well and changed key parts of it. They included Jeff Saleeby, a Salisbury insurance agent who said he’s been directing clients to SHIIP for years.
“You could go to the site, NCshiip.com, and scroll down to where you see the comparison database, and you can get an unbiased view all at one time right in front of you, not somebody feeding it to you,” Saleeby said.
SHIIP leadership rolled back the decision Monday, leaving the outside source in place, but, in addition, reinstating the public-facing database familiar to many Medicare beneficiaries.
The decision to add back the former presentation, made by Melinda Munden, SHIIP director, followed questions from North Carolina Health News and from others who use the system, Department of Insurance officials said.
‘It’s not the best’
Among those questioning the move had been an older woman who was used to logging into the SHIIP system and going straight to the plan descriptions that had been compiled by state employees, said Marla Sink, deputy commissioner for communications at the state Department of Insurance.
“If they’re researching late at night and they want to get on, it’s not the best information but it’ll give them an idea,” Sink said.
For people over 65 and eligible for Medicare, the choice of a supplement or Medicare Part B, which pays for doctor’s visits and other services, can be crucial in terms of health and spending. Part A, mostly for hospitalization, is taken out of beneficiaries’ Social Security payments.
Gina Upchurch, of Durham, is founder and director of Senior PharmAssist, a nonprofit that helps lower-income people with prescription drug issues. There are pros and cons to the new system, she said, but a big negative would be the loss of hands-on control for an age cohort that is increasingly computer- and media-savvy.
Some difficulties in negotiating reams of information in the new system involve significant inconveniences such as having all the phone numbers on separate pages in the newer database.
“My biggest concern is that it’s not consumer-facing,” Upchurch said. “I may give Miss Jones three of the top three choices, but then she may decide ‘I don’t want any of them.’”
Correction: This story has been changed to note that the senior pharmacy “donut hole” was created with the rollout of the Medicare Part D prescription drug plan.
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