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'This is not right': Medicare's plan guide was so messed up, it's offering a do-over

Kansas City Star - 1/1/2020

Jan. 1--Medicare counselor Kelly G. Loeb helped 92 people enroll in their health care plans this past year, but it was tougher than usual.

The Centers for Medicare and Medicaid Services added a new planning tool to its website, and it was so confusing -- even for experts like Loeb -- that congressional leaders have called for officials to publicize a special do-over period to give recipients another chance to enroll in the right plan.

Loeb and other Medicare counselors worry that Medicare users could feel the aftershocks when they get their prescriptions this month.

"I think the first clue is going to be when they go to the pharmacy on Jan. 2 and they try to pick up a medicine and they're expecting it to cost X and it costs 3X," said Loeb, the manager of older adult care for Jewish Family Services of Greater Kansas City.

"And they're going to say, 'Wait a minute, this is not right.' That's probably going to be their first clue, that their medicine is going to cost more. Or it's not going to be covered, or their pharmacy is not going to be in network, or something like that is going to happen."

The problem is the Plan Finder, the tool on Medicare.gov that lets recipients compare prices and benefits. The Plan Finder had a new look, the first redesign in a decade, and it hit a few bumps.

Fifteen senators urged Medicare to tell recipients that a fix is available. Recipients can apply for a special enrollment period if they think they chose a plan based on faulty information from the Plan Finder.

Special enrollment periods have always been available under certain circumstances. But senators worried people don't know, so they sent a letter to Medicare administrator Seema Verma in early December to make sure word gets out.

They wrote that "incorrect or incomplete information" on coverage and costs from Plan Finder could prove burdensome.

"While we appreciate the agency's efforts to be responsive to concerns expressed about the new tool, we remain concerned that seniors and people with disabilities who enroll in a health plan based on inaccurate information produced by the tool may not be aware that there is an opportunity to revisit their coverage choice," said the letter.

"I could see the intent to make it more visually appealing, and more user-friendly," said Loeb. "I'm an experienced Medicare counselor. I've been doing this for eight years, and I found it a challenge to use.

"So I think that someone trying to do it on their own who had maybe never even tried to use the Plan Finder before was being set loose in dangerous territory."

State Health Insurance Assistance Program --or SHIP -- counselors like Loeb expect a rush after Jan. 1, when new plans go into effect and people start calling with questions.

"You're not going to know you're in the wrong plan until after January 1 when you go to the counter and try to use your plan," said long-time Medicare counselor Leslea Rockers at the East Central Kansas Area Agency on Aging in Ottawa.

"Until you go to the pharmacy for the first time in 2020, you have no idea if you're in the right plan or the wrong plan, or if the math is going to be right."

Simple prompts, easy on the eyes

The Centers for Medicare and Medicaid Services launched the new Plan Finder -- the most-used tool on Medicare.gov -- "to make it easier for people to compare pricing, benefits and select the plan options that best meet their needs," the department said in a statement to The Star.

It had received many complaints over the years about the old Plan Finder's "functionality and usability."

Operationally, the new version "performed very well and there were no disruptions or downtime for beneficiaries during Open Enrollment. ... We've listened to Medicare web users and redesigned the experience -- with simple prompts, clean design and fonts, and colors that are easy on the eyes."

"I will be the first to admit," Loeb said, "there are some things about the Plan Finder that I think are improvements over the old Plan Finder, and they are improvements because they just didn't exist in the old Plan Finder before."

For example, she said, the Plan Finder can provide a list of the medications patients take.

"One of the most important things people have to bring when they come for a counseling appointment with me is a list of the medicines that they take. And I say that about 27 times when I talk to someone. I say, 'Please bring your red, white and blue Medicare card, please bring your list of medicines.'

"More people than you might think either forget or say, 'I didn't know you really meant that.' Or, 'I take this one yellow pill three times a day. Don't you know what that is?'

"So it's been really helpful to have the new Plan Finder say, 'I see you have taken this blood pressure medicine. Are you still taking that?' That has been absolutely wonderful."

Loeb also liked a feature that lets recipients print out new Medicare cards, and a new live chat. "Most of the people I have chatted with have been pretty helpful," she said.

Bad math

But Medicare counselors found that the numbers Plan Finder presented in some instances just didn't add up or were inaccurate. Some counselors didn't like the way the costs of health plans were presented.

"The really wonderful thing about the Plan Finder, just as a tool in general, is that it is supposed to lay out in a very clear way what options a person has for coverage," said Loeb. "And because most people are wanting to spend the smallest amount of money possible, the Plan Finder should be a tool that they can use to find coverage that is going to be overall the lowest amount that a beneficiary can spend.

"With the new Plan Finder, the way to access that information was not always clear."

She and other counselors didn't like how the new Plan Finder displayed plans according to lowest premium costs instead of lowest overall plan costs.

"Who cares if you pay $13 a month if the cost of your drugs at the end of the year on that plan is $500 more than it would have been on a plan that had a $30 premium?" said Rockers.

On the new tool, "when you sort the information, it does not have an option for lowest overall cost," said Loeb. "You can sort plans by lowest monthly premium, lowest drug deductible, and lowest drug plus premium cost, and none of those options are particularly obvious to me, and I know what I'm looking for. You can ultimately determine that lowest overall cost, but it's not intuitive."

Plan Finder reportedly gave incorrect prices, too. Counselors said they compared prices from the Plan Finder to costs cited on insurance companies' websites and they didn't always match.

"Alarmingly, SHIP counselors and beneficiary advocates alike report the (Plan Finder) returning incorrect prescription drug pricing information that would amount to thousands of dollars in out-of-pocket costs for people with Medicare," the senators -- led by Sen. Bob Casey, a Pennsylvania Democrat and ranking member of the Special Committee on Aging -- wrote in their letter to the agency.

Rockers said she didn't start trusting Plan Finder's numbers until about the first week of November, "because that's when we saw things started to at least look more consistent.

"So we lost about two weeks of open enrollment helping people because we were afraid the calculations were so wrong. So anybody that didn't go through an agency like ours who were told 'Hey beware, they don't have the bugs worked out yet,' could have enrolled in something that gave them faulty math."

No need to know what an SEP is

Outside of open enrollment every fall, Medicare users have very few chances to "join, change or leave a Medicare Advantage Plan or prescription drug plan (Part D)," Medicare says.

Unless, that is, they qualify for a special enrollment period, or SEP, available to recipients who have moved, lost their insurance coverage or experienced other changes in their lives.

This year, having problems with Plan Finder can qualify a recipient for that special do-over.

"We've never before been told, 'hey, if you think the math was wrong we're going to give you a special enrollment period,'" said Rockers.

A notice explaining that appears in an eye-catching gray box on the Medicare website.

It reads: "If you believe you made the wrong plan choice because of inaccurate or misleading information, including using Plan Finder, call 1-800-MEDICARE and explain your situation. Call center representatives can help you throughout the year with options for making changes."

Medicare said it has always had the ability to grant the do-over "to beneficiaries under exceptional circumstances at any point during the year.

"This SEP for exceptional circumstances isn't new, and each year can be used for a beneficiary who believes they made the wrong plan choice because of inaccurate or misleading information, but this year we're doubling down on ensuring that the SEP process is a simple and painless experience for beneficiaries."

For one thing, recipients don't even have to know the term "SEP."

"Call center representatives are trained to provide SEP information to beneficiaries regardless of their usage of the term," Medicare said. "They can simply explain their concerns to the call center representative who can guide them through the rest of the process."

Jill Conyers has walked people through the special enrollment period process and said the changes to their plans came fairly quickly. She is a SHIP counselor and the Medicare assistance program manager at the Shepherd's Center Central in Kansas City, which helped hundreds of Kansas Citians enroll in Medicare this year.

The nationwide network of trained SHIP counselors helps recipients, their families and caregivers navigate the often confusing Medicare system. (The program is called SHICK in Kansas.)

And, if anything, the problems with the new Plan Finder put a spotlight on SHIP counselors and their services, which are free to the public. The SHIP program is run by the Administration for Community Living, a part of the Department of Health and Human Services.

"This is why we need continued advocacy for funding for the SHIP program, because we are the people (Medicare recipients) can contact in any state," said Conyers. "They continually want to cut funding at the national level for SHIP, but this is why it's so important."

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