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Vanessa Barrington

In AEP Home Stretch, CMS Grapples With Plan Finder ‘Glitches’

By | Medicare

Reprinted with AIS Health permission from the December 5, 2019, issue of RADAR on Medicare Advantage

Despite a major overhaul to the Medicare Plan Finder (MPF) that was readied in time for the Annual Election Period ending on Dec. 7, multiple reports at press time indicated that the online tool was providing inaccurate cost estimates for users, especially relating to prescription drugs. In a blog post responding to the reports, CMS said it stands by the accuracy of the tool, but it acknowledged that it has been making updates to the MPF as issues are flagged, giving weight to consumer advocates’ concerns that CMS did not allow enough time for testing the tool before rolling it out.

With the goal of offering a more streamlined and personalized shopping experience at Medicare.gov, the MPF this year underwent a major makeover that reportedly cost $11 million. Sources such as the Consumer Assessment of Health Plans Survey, the “Modernizing Medicare Plan Finder” report from the National Council on Aging and RAND research had raised multiple navigability issues with the tool and prompted CMS to take on the redesign. But after promising consumer advocacy groups that the new version would be available to use alongside the legacy MPF for “much of the summer,” CMS dropped the new plan finder on Aug. 27 — just seven weeks before the Oct. 15 start of the AEP.

“The Medicare Plan Finder is a critical tool for beneficiaries to make plan selections — and even more so this year in which Medicare beneficiaries on average have the choice of 28 different [stand-alone Part D] plans to enroll in,” says Amber Christ, directing attorney with Justice in Aging, referring to a recent Kaiser Family Foundation analysis.

“At the outset, CMS did not provide enough time to test the functionality of the tool, which has led to ‘testing in real time’ with real ramifications to Medicare beneficiaries and their ability to access care,” laments Christ. Shortly after the MPF’s late August unveiling, Justice in Aging joined with the Center for Medicare Advocacy, the Medicare Rights Center and the National Council on Aging to issue a letter to CMS arguing that it did not give counselors enough time to familiarize themselves with the tool, and criticizing the decision not to allow them to fall back on the legacy MPF, which was retired at the end of September.

Meanwhile, a key feature of the tool was missing: the ability to sort Part D plans based on a beneficiary’s total out-of-pocket drug costs for the rest of the year.

CMS explained to AIS Health in September that the feature was always meant to be included in the new plan finder but couldn’t be completed in time for the late August launch. And the agency did indeed add it by the start of the AEP, when it also began enabling consumers to compare expected drug costs in stand-alone Part D plans and MA plans with prescription drug coverage and automatically load their current prescription drug list (if they are existing Medicare beneficiaries and provide their Medicare ID number).

Reports Suggest Emphasis on Premiums

But a recent Health Affairs article observed that the new MPF “explicitly emphasizes the monthly plan premium over arguably more relevant information — estimated total drug costs — which also account for expected out-of-pocket costs.” Meanwhile, total drug costs are “displayed in a small font amidst other information,” and the tool lists available plans starting with the lowest premiums, potentially steering users toward plans with low premiums when previous research has suggested this leads beneficiaries to spend more than necessary on yearly drug expenses, observed the article.

Other news reports offered detailed accounts from users around the country. When using the MPF to compare three drug plans for a client, a Medicare consultant in Wisconsin found that the summary page indicated that one of her client’s medications would not be covered — but upon clicking on “plan details” was informed that all of them would be covered, according to a Nov. 25 article from ProPublica. Further research on the plans’ websites revealed that coverage depended on which version of the same high blood pressure medication the member was taking.

In North Carolina, officials with the state’s Seniors’ Health Insurance Information Program told North Carolina Health News that costs for enrollees who receive low-income subsidies were not accurately reflected in the plan finder, and another not-for-profit agency reported that beneficiaries who entered their new Medicare ID numbers saw their forms automatically repopulate with their Social Security numbers, which were supposed to be removed from the process. And an administrator in Nebraska’s Dept. of Insurance told ProPublica that she’d flagged about 100 errors with the new tool since Oct. 1.

CMS: Information Is ‘Current,’ ‘Accurate’

“Distressed” by “the media coverage talking about ‘glitches’ or ‘malfunctions’” in the MPF, a CMS blog post dated Nov. 27 with no byline said the new tool “displays the most current and accurate information on premiums, deductibles and cost sharing that Medicare Advantage and Prescription Drug Plans provide.” That information, added CMS, “changes frequently because plans regularly update drug formularies and renegotiate drug prices,” which is “good for beneficiaries.”

CMS also reported that traffic on the plan finder website is 14% higher than last year and that the agency is already “seeing high percentages of plan switching, likely because new supplemental benefits are appealing.” However, the agency is not done improving the tool and has incorporated additional changes during the AEP as it receives feedback from users and stakeholders, including beneficiaries, caregivers and State Health Insurance Program counselors who have provided “meaningful suggestions,” added the blog post. “As we’ve said, the Plan Finder redesign is an iterative project, and in the coming months we’ll be scoping out additional improvements that we can implement based on lessons we learn this year.”

“We appreciate that CMS is working diligently to address problems that come up,” says Christ. “Our concern is that many people have already made decisions based on inaccurate plan finder information.”

Advocates Want More Flexible SEP

To ensure that beneficiaries do not experience harm, Justice in Aging has asked CMS to make the Special Enrollment Period (SEP) more flexible and to widely advertise its availability, she adds. The SEP applies when beneficiaries receive inaccurate or misleading information from the government, but it is generally narrow and requires burdensome documentation by beneficiaries, according to Justice in Aging.

That’s not to be confused with the three-month Open Enrollment Period, which starts in January and allows individuals who made an MA plan choice to switch. While that period may “help a subset of individuals who early on realize their plan selection is harmful…many won’t encounter a problem until later in the year, and they too need a way to fix a mistake that was based on erroneous or misleading plan finder information,” suggests Christ. Furthermore, the three-month open enrollment period only applies to MA, and not to PDP enrollment, she points out.

Even with MPF glitches, the AEP appears to be robust, with overall year-to-date enrollment up 7.2%, according to Credit Suisse. “The big ‘wait and see’ question will be if and when enrollees depending on Plan Finder realize they received incorrect information,” says Lindsay Resnick, executive vice president at Wunderman Thompson Health, in an email to AIS Health. “Given that the vast majority of beneficiaries complete their purchase through a licensed Medicare Advantage agent or directly with the health plan, we may not see major issues. That said, for the integrity of the MA program, the onus is on CMS to get in front of this issue with consumer facing communications about Plan Finder issues as well as clear and simple explanations of OEP rules.”

Meanwhile, private shopping platform Connecture — which prides itself on using pharmacy-specific drug pricing data (not just regional averages) collected from the largest number of carriers in the country — says it has seen significant growth in enrollments this AEP through all channels (broker, call center and direct-to-consumer) via its PlanCompare solution.

Connecture: Calculating Drug Costs Is Key

“This AEP, especially, has afforded Connecture the opportunity to educate on the importance of collecting (and saving) drug lists, knowing accurate drug costs and understanding why $0 premium plans can end up costing more if consumers don’t understand their total annual out-of-pocket estimates,” says Bill Keyes, senior vice president of sales and marketing with Connecture. “Our total cost calculators take multiple Medicare plan factors into consideration (such as the donut hole) all of which ultimately drive consumers to finding their best fit plans.”

View the Health Affairs article at https://bit.ly/2R8WK7L and the CMS blog post at https://go.cms.gov/2qYbEmJ.

Contact Christ via Vanessa Barrington vbarrington@justiceinaging.org, Keyes via Connecture Marketing Director Kara Tarantino at ktarantino@connecture.com or Resnick at lindsay.resnick@wunderman.com.

By Lauren Flynn Kelly

Medicare Doesn’t Cover Dental Care. For Many Florida Seniors, That’s a Problem

By | Health Equity, IN THE NEWS, Medicare, Oral Health, Uncategorized

Miami Herald: Medicare Doesn’t Cover Dental Care. For Many Florida Seniors, That’s a Problem (December 20, 2019)

Spotty coverage — combined with high oral health costs — means many older adults like Domínguez and Morejón, the two people discussed in this story, have no path to getting dental care. According to Justice in Aging, a national non-profit legal advocacy organization, only half of all 60 million Medicare beneficiaries saw a dental provider in the past year. “When we speak with older adults, lack of access to dental care is very much top of mind for them,” said Jennifer Goldberg, Justice in Aging’s Deputy Director. “And that lack of access to dental coverage has a disparate impact on populations of color.”

Dozens of Senior Care Homes That Broke Labor Laws Continue to Get Medicaid Funds

By | IN THE NEWS, Medicaid, Nursing Homes

Reveal from The Center for Investigative Reporting: Dozens of Senior Care Homes That Broke Labor Laws Continue to Get Medicaid Funds (December 14, 2019)

This story is the fourth in an investigative series about wage theft and worker exploitation in Medicaid-funded board and care homes in California, Florida, Oregon, and Wisconsin. Companies may be prohibited from collecting Medicaid if they have been convicted of Medicare or Medicaid fraud or patient abuse or neglect, among other offenses. However, the federal agency that administers Medicaid – the Centers for Medicare & Medicaid Services – does not police whether senior care-home operators comply with wage and hour laws. “Medicaid certification is a privilege, not a right, and payment should depend upon complying with relevant laws,” said Eric Carlson, a directing attorney at Justice in Aging. “Underpaying employees is a red flag for health care quality.” This story also appeared in The New York Times, Washington Post, Minneapolis Star Tribune, Seattle Times, US news and World Report, and the San Diego Union Tribune.

California’s Master Plan For Aging: Make Medi-Cal More Affordable

By | FACT SHEET, Long Term Care, Medicaid, Toolkit

California has committed to developing a Master Plan for Aging in order to meet the needs of older adults today and for generations to come. Justice in Aging will release a series of short papers containing specific policy recommendations, developed with partners, that the Master Plan for Aging must include to meet its goals to advance equity, increase economic security and safety, and improve access to quality, affordable health care and LTSS programs.

The first in this series of papers, Make Medi-Cal More Accessible and Affordable, offers eight specific policy recommendations for improving Medi-Cal in order to ensure that every low-income older adult in California is able to access high quality, affordable health care. This paper was developed with developed with partners at Disability Rights California and Western Center on Law & Poverty.

 

Trump Administration Proposes Social Security Rule Changes that Could Cut off Thousands of Disabled Recipients

By | IN THE NEWS, Supplemental Security Income

The Philadelphia Inquirer: Trump Administration Proposes Social Security Rule Changes that Could Cut off Thousands of Disabled Recipients (December 12, 2019)

The Trump administration is proposing changes to Social Security that could terminate disability payments to hundreds of thousands of Americans, particularly older people and children. The new rule would change they way they classify people with disabilities and institute more frequent disability determinations, pushing more people into an already overloaded system, and slowing it down for everyone. The ultimate result will be people losing benefits, particularly people 50-65 years old. Justice in Aging attorney Kate Lang said, “they’re out to shrink the rolls. And they’re setting people up to not comply.”

In AEP Home Stretch, CMS Grapples with Plan Finder “Glitches”

By | Health Care, IN THE NEWS, Medicare

AIS Health: In AEP Home Stretch, CMS Grapples with Plan Finder “Glitches” (December 5, 2019) RADAR on Medicare Advantage

Despite a major overhaul to the Medicare Plan Finder (MPF) that was readied in time for the Annual Election Period ending on Dec. 7, multiple reports at press time indicated that the online tool was providing inaccurate cost estimates for users, especially relating to prescription drugs. In a blog post responding to the reports, CMS said it stands by the accuracy of the tool, but it acknowledged that it has been making updates to the MPF as issues are flagged, giving weight to consumer advocates’ concerns that CMS did not allow enough time for testing the tool before rolling it out.

“At the outset, CMS did not provide enough time to test the functionality of the tool, which has led to ‘testing in real time’ with real ramifications to Medicare beneficiaries and their ability to access care,” said Directing Attorney, Amber Christ. This article is behind a paywall, but the publisher, allowed us to reprint it. Click below to read the full story.

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Many Enrolled in California Healthcare Plan Lack Interpretation Services, Surveys Show

By | DUAL DEMONSTRATIONS, DUAL ELIGIBLES, IN THE NEWS, Language Access, Medicaid, Medicare

The Sacramento Bee: Many Enrolled in California Healthcare Plan Lack Interpretation Services, Surveys Show (November 6, 2019)

Half of the non-English speaking people enrolled in Cal MediConnect reported they could never get a medical interpreter when they needed one, according to a survey conducted by San Francisco State University. Currently, Cal MediConnect is a pilot program that coordinates care for dual eligibles in seven California counties. However, a similar program will be rolled out that requires all of California’s dual eligibles to receive care through managed care plans. This new program is called CalAim. “Our experience in Cal MediConnect can be used to predict where potential language access barriers might be in this new model ‘CalAim’,” said Denny Chan, senior staff attorney at Justice in Aging. “Sooner or later, this will affect all duals across California. The agencies want to move people to managed care plans across the state, so it is important for us to make sure these problems don’t continue.”

Retirement Home Had Bedbugs. It’s Closing. But Could Residents End up Somewhere Worse?

By | IN THE NEWS, Nursing Homes

Miami Herald: Retirement Home Had Bedbugs. It’s Closing. But Could Residents End up Somewhere Worse? (October 31, 2019)

Residents of a Florida retirement home with a history of issues learned suddenly that the home was closing and they’d be moved elsewhere, but they were given no choice or information about where they were moving. This is a common problem according to Justice in Aging attorney, Eric Carlson. “Facilities will just kind of send people out and that is inappropriate,” he said. “You are deciding where you live. It is a big deal. And that should be based on what the person wants, not on what is most convenient for the professionals and facility people who are involved in this process.”

New Federal Warning Flags Abuse at 3 Louisiana Nursing Homes

By | IN THE NEWS, Nursing Homes

New Orleans Times Picayune: New Federal Warning Flags Abuse at 3 Louisiana Nursing Homes (October 24, 2019)

The Centers for Medicare and Medicaid Services (CMS) has rolled out a warning system on its Nursing Home Compare site to alert consumers to nursing homes that the agency has cited for abuse. This story focuses on the three nursing facilities in Louisiana that display the warning. Even though the symbol doesn’t provide further information about what types of abuse the nursing facilities were cited for, Justice in Aging attorney Eric Carlson noted that it’s an important first step to give consumers information. “These are documented findings of abuse and it’s important that prospective residents be aware of that,” he said.

W & M Eyes Rx Savings to add Part B Benefits, GOP Would Hike Trust Fund

By | Health Care, IN THE NEWS, Medicare

Inside Health Policy: W&M Eyes Rx Savings To Add Part B Benefits, GOP Would Hike Trust Fund (October 22, 2019)

The House Ways & Means Committee passed legislation to add vision, hearing and dental benefits to Medicare Part B. Justice in Aging is in support of this legislation because these benefits are necessary for Medicare recipients to be able to afford to pay for the care they need. Jennifer Goldberg, Justice in Aging’s Deputy Director, was interviewed for this article in which she shared Justice in Aging’s view that adding these benefits to Part B would be consistent with the growing recognition that oral health care should be more fully integrated into overall health, both in Medicare and more broadly, and that doing so will not impact the Medicare Trust Fund. Justice in Aging sent a letter to Ways & Means and the House Energy & Commerce Committee in strong support of H.R. 3. This article is behind a paywall. This is a summary.