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Medicare Plan Finder Updates May Adversely Affect Enrollees

If you utilized the online Medicare Plan Finder to help you choose a Medicare health or drug plan for 2020, you may end up with higher than expected costs.

The government made significant changes to this tool this year, since it hadn’t received a comprehensive update in over 10 years.

 Some of the updates which were made did have positive results.  The Medicare Plan Finder can now be used on a smartphone or tablet due to the development of a mobile version.  Also new is the ability of users to compare costs between different types of plans, such as Part D standalone plans with Medicare Advantage plans which include drug coverage. 

The plan finder now also features automatic loading of a Medicare recipient’s medication list (as long as the individual has already been enrolled in Medicare and provides a Medicare ID number).  While this automatic list should be reviewed for accuracy, it may save significant time compared to entering medications manually, and may also reduce the receipt of incorrect plan information due to misspelled medication names or incorrectly entered dosages.

One of the major changes which has created concern is how the plan finder sorts and displays an individual’s options.  Once the necessary personal information was entered to determine appropriate plans, the plan finder previously displayed the plans in order of lowest overall cost to highest overall cost.

The recent changes now have plans sorted by lowest to highest premium cost, which doesn’t account for additional expenses such as copays and medication expenses. The total cost is still displayed but it is in smaller print and is located off to the side.   Advocates for older adults have pointed out that it may be challenging for Medicare enrollees to take extra steps to determine the plan with the lowest overall cost, and that many people may not have recognized this change in the system.

Another potential complication with the new format is specific to medications.  The list of medications which are covered under any particular plan is the formulary for that plan.  Even if all of an individual’s medications are not part of a specific plan’s formulary, the Medicare Plan Finder may provide that plan as a choice for an enrollee.  The fact that not all of the individual’s medications are covered may not be readily apparent.  One potential clue to this scenario is plans which have low premiums but high out of pocket costs.  Additional digging into the details of a desired plan is recommended.

What happens now since the enrollment period has ended?  Medicare beneficiaries should carefully monitor their Medicare expenses beginning January 1, 2020.  If they find that they are spending more than anticipated, they should call Medicare at 1-800-MEDICARE and ask to change their plan.  Based on the circumstances, Medicare may determine that a special enrollment period (SEP) is appropriate. A new plan may be chosen during this SEP.

A number of U.S. Senators have urged the Centers for Medicare and Medicaid Services (CMS) to accommodate all enrollees who request a change due to feeling misled by the recent updates to the Medicare Plan Finder.

Health care consultants and advocates have identified several additional methods by which the Medicare Plan Finder could be further improved.  Ease of use and accuracy of information for the Plan Finder should be top priorities for CMS as they seek to assist Medicare eligible individuals to navigate the complexities of choosing Medicare coverage.

Karen Kaslow, RN, BSN