WASHINGTON — Medicare’s revamped prescription plan finder can steer unwitting seniors to coverage that costs much more than they need to pay, according to people who help with sign-ups as well as program experts.
Serving some 60 million Medicare recipients, the plan finder is the most commonly used tool on Medicare.gov and just got its first major update in a decade. The Trump administration has hailed the new version and Medicare Administrator Seema Verma says it will empower beneficiaries to take advantage of their coverage options.
But as open enrollment goes into the home stretch Thanksgiving week, critics say the new tool can create confusion by obscuring out-of-pocket costs that seniors should factor into their decisions.
“I want to make sure people are given the most accurate information and they’re making the best decision — because they are the ones stuck with it,” said Ann Kayrish, senior program manager for Medicare at the National Council on Aging, a nonpartisan organization that advocates for seniors and provides community services.
Government programs mixing health care and technology have faced struggles. Despite billions spent to subsidize electronic medical records, getting different systems to communicate remains a challenge. The Obama administration’s launch of HealthCare.gov resulted in an embarrassing debacle when the website froze up the first day.
The leading Democrat on the Senate Aging Committee said he’s hearing concerns from constituents and organizations that assist Medicare beneficiaries. Pennsylvania Senator Bob Casey said he will ask Medicare to grant seniors who’ve had problems a second chance to sign up, called a “special enrollment period.”
“It’s obviously an effort that needs a lot more work to meet the legitimate expectations of seniors,” said Casey. “Especially when you launch something new, (it) can go awry. People steered in the wrong direction should get a measure of fairness.”
The Medicare plan finder’s issue stems from a significant change the agency made for 2020.
The plan with the lowest premium now gets automatically placed on top, with the monthly premium displayed in large font.
Medicare’s previous plan finder automatically sorted plans by total cost, not just premiums.
But premiums are only one piece of information.
When out-of-pocket expenses such as copays are factored in, the plan with the lowest total annual cost is often not the first one shown by the plan finder.
It takes extra work for a Medicare enrollee to discover that.
“If they pick the plan based solely on the premium they are likely getting a plan that could cost them thousands more in a calendar year,” said Christina Reeg of the Ohio Department of Insurance. She heads a program that helps Medicare enrollees try to find the right plan.
In a statement, Medicare said the monthly premium is a cost that consumers understand and will always be an important decision factor.
But the agency also said total cost paid out-of-pocket is at least equally, if not more important, particularly for people who take prescription drugs — as do most seniors. Medicare said it’s testing ways to encourage consumers to look at total costs, such as a pop-up.