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Asclepios
Your Weekly Medicare Consumer Advocacy Update
Hard Times
October 2, 2008; Volume 8, Issue 40
Later this month, many people with Medicare will receive a fat letter from the
prescription drug or Medicare private health plan that describes the changes in
benefits and premiums coming in 2009. Those with the stamina to wade through the
document may find that drugs they take will no longer be covered, or that copays
for hospital stays or premiums will be higher. People who give up in
frustration, or who do not receive the notice in time, will find out about the
changes when they go to the pharmacy in January or when they get the bill for
their premium.
Consumers would have an easier time of it if the annual notice of change were
personalized. People could receive information on changes related to the drugs
they take, and to the level of subsidy they receive for drug coverage as well as
changes of more general interest, like hospital copayments. The Centers for Medicare & Medicaid Services (CMS)
has repeatedly rejected this suggestion, even though plans provide such
personalized information in the monthly statements they send to their members.
It would also help if CMS's plan finder website, Medicare.gov, were more
consumer-friendly and more accurate. In past years, consumers have seen sharp
increases in the prices quoted for their drugs from one month to the next. The
plan finder also invariably makes Original Medicare look like the much more
expensive option compared to Medicare private health plans. That is because
there is no mechanism for comparing the combined costs of a Medigap supplemental
policy and a stand-alone drug plan with the cost of a Medicare Advantage plan
with drug coverage. Inexplicably, the plan finder also calculates that people
will spend $2000 more on health services under Original Medicare than under
Medicare private health plans, like WellCare Melody, that have exactly the same
cost-sharing structure as Original Medicare.
Unfortunately, these are not the only examples of information coming from CMS
that paints the privatized Part D drug benefit and Medicare private health plans
in the best light, even if they wind up confusing consumers. Even as premiums
for most people enrolled in prescription drug plans are rising sharply in 2009,
CMS put out a press release boasting that 97 percent would have "access" to a
prescription drug or Medicare private health plan with the same, or lower,
premium. That may be true, but it neglects to mention that people may have to
change plans, and may also need to change doctors if the only cheaper plan for
drug coverage is an HMO. This clever parsing of words is what we expect from
politicians, not from an agency that should be committed to ensuring that people
with Medicare receive quality and affordable health care.
CMS has also demonstrated an abysmal record of oversight, allowing insurance
companies to push plans that discriminate against people with high medical costs, including people with specific diseases like
cancer, and allowing companies that consistently violate marketing rules to
expand their territory.
The only thing that seems to get CMS's attention are bad press and congressional
hearings.
That's where you come in. Is your plan raising premiums, cutting back on drug
coverage or hiking your copayments for medical care? Are you getting the
runaround from your plans' customer service representatives or from
1-800-Medicare? Are agents knocking on your door or calling you on the phone to
sell a Medicare plan, despite a new law that prohibits "unsolicited" marketing?
Tell us your story.
(http://www.kintera.org/TR.asp?a=dtLTL7OGIcINIcK&s=olJVKcO1LqLYKaM4F&m=mwIWJ8MVJ
hL5G&af=y)
Asclepios
Your Weekly Medicare Consumer Advocacy Update
Hard Times
October 2, 2008; Volume 8, Issue 40
Later this month, many people with Medicare will receive a fat letter from the
prescription drug or Medicare private health plan that describes the changes in
benefits and premiums coming in 2009. Those with the stamina to wade through the
document may find that drugs they take will no longer be covered, or that copays
for hospital stays or premiums will be higher. People who give up in
frustration, or who do not receive the notice in time, will find out about the
changes when they go to the pharmacy in January or when they get the bill for
their premium.
Consumers would have an easier time of it if the annual notice of change were
personalized. People could receive information on changes related to the drugs
they take, and to the level of subsidy they receive for drug coverage as well as
changes of more general interest, like hospital copayments. The Centers for Medicare & Medicaid Services (CMS)
has repeatedly rejected this suggestion, even though plans provide such
personalized information in the monthly statements they send to their members.
It would also help if CMS's plan finder website, Medicare.gov, were more
consumer-friendly and more accurate. In past years, consumers have seen sharp
increases in the prices quoted for their drugs from one month to the next. The
plan finder also invariably makes Original Medicare look like the much more
expensive option compared to Medicare private health plans. That is because
there is no mechanism for comparing the combined costs of a Medigap supplemental
policy and a stand-alone drug plan with the cost of a Medicare Advantage plan
with drug coverage. Inexplicably, the plan finder also calculates that people
will spend $2000 more on health services under Original Medicare than under
Medicare private health plans, like WellCare Melody, that have exactly the same
cost-sharing structure as Original Medicare.
Unfortunately, these are not the only examples of information coming from CMS
that paints the privatized Part D drug benefit and Medicare private health plans
in the best light, even if they wind up confusing consumers. Even as premiums
for most people enrolled in prescription drug plans are rising sharply in 2009,
CMS put out a press release boasting that 97 percent would have "access" to a
prescription drug or Medicare private health plan with the same, or lower,
premium. That may be true, but it neglects to mention that people may have to
change plans, and may also need to change doctors if the only cheaper plan for
drug coverage is an HMO. This clever parsing of words is what we expect from
politicians, not from an agency that should be committed to ensuring that people
with Medicare receive quality and affordable health care.
CMS has also demonstrated an abysmal record of oversight, allowing insurance
companies to push plans that discriminate against people with high medical costs, including people with specific diseases like
cancer, and allowing companies that consistently violate marketing rules to
expand their territory.
The only thing that seems to get CMS's attention are bad press and congressional
hearings.
That's where you come in. Is your plan raising premiums, cutting back on drug
coverage or hiking your copayments for medical care? Are you getting the
runaround from your plans' customer service representatives or from
1-800-Medicare? Are agents knocking on your door or calling you on the phone to
sell a Medicare plan, despite a new law that prohibits "unsolicited" marketing?
Tell us your story.
(http://www.kintera.org/TR.asp?a=dtLTL7OGIcINIcK&s=olJVKcO1LqLYKaM4F&m=mwIWJ8MVJ
hL5G&af=y)
