In many ways, the problems of complexity that plague the Medicare program reflect the disjointed nature of the U.S. healthcare system. There are steps that policymakers could take to make life easier for Medicare patients and providers. Most of them fall into one of two buckets: reducing the likelihood that someone will pick the wrong plan and lowering the risk of choosing the wrong plan. But none of the proposed solutions would fix the root cause of consumer confusion: health insurance is too complicated for most people to truly comprehend.
- The CMS recently overhauled its Medicare Plan Finder tool, and it might want to give a second overhaul a try. Consumer groups argue that it’s still too confusing and doesn’t provide beneficiaries with clear information about critical out-of-pocket costs.
- The federal government’s Medicare and You handbook could use some upgrades. It’s a 120-page repository of nonpartisan Medicare information, but it’s still hard for beneficiaries to understand how to use the information in their everyday decision-making. More real-world examples of how different plans and benefits apply to particular situations could help. “I’m a trained healthcare attorney,” said Helaine Fingold, with Epstein Becker Green. “(But) it’s hard to visualize and put together the pieces.”
- Improving the reliability of information available to beneficiaries would be welcome. Nearly half of Advantage online provider directories had at least one error, according to a CMS-funded report.
- More funding for state health insurance assistance programs is needed, primarily for benefits counselors. Funding for these programs hasn’t kept pace with the ever-expanding Medicare rolls and plan options. Boosting the number of counselors and improving the training they receive could lead to better-informed decisions about beneficiaries’ coverage options.
- Baby boomers introduce complexities into the Medicare enrollment process. Many are still working and employers are ill-equipped to help them with their Medicare needs like how it intersects with COBRA coverage. Workers aren’t used to choosing between more than a few plans. The CMS should develop more resources and programs to help employers assist their workers’ transition to Medicare, experts say. “Human resources departments don’t know the answers to their (Medicare-related) questions,” said former congresswoman Allyson Schwartz, CEO of the Better Medicare Alliance.
- Policymakers could make it easier for Medicare beneficiaries to purchase a Medigap plan after initial enrollment by mandating guaranteed issue of Medigap plans in every state, as Connecticut, Maine, Massachusetts and New York do already. It would lessen the risk of leaving an Advantage plan after initial enrollment.
- The federal government should be required to notify people about their Medicare eligibility before they turn age 65, and align Medicare Part B enrollment with the fall enrollment period for Medicare Advantage and prescription drug coverage, both of which are in the proposed, bipartisan Beneficiary Enrollment Notification and Eligibility Simplification Act.
