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The Informed Consumer
March 5, 2009 • Volume 9, Issue 9
Medicare is complicated.
There are pages of rules governing how Medicare coverage works—how it coordinates with coverage through your employer coverage, or with your retiree plan, what rights you have to obtain supplemental coverage, and whether your income and assets are low enough to qualify for help with your drug costs.
On top of all that, there are about 50 drug plans to choose from, and often an even greater number of HMOs, PPOs and every other flavor of Medicare private health plan. Each plan covers different drugs, sets different copays for doctor visits and hospital stays and may, or may not, provide you with financial protections against the cost of treating a serious illness. Not surprisingly, many people with Medicare are confused, and they have questions.
Where can they go for straight answers in plain language? The Medicare Rights Center is one source—we run a hotline and have a web site (MedicareInteractive.org) where you can get answers to many of your questions. Each state also has a State Health Insurance Assistance Program (they go by different names in different states), with a staff trained to help Medicare consumers. But SHIP programs are woefully underfunded and other advocacy organizations receive no federal funding at all.
Millions turn to 1-800-Medicare, but, even though Medicare pays more than $250 million for the call center, it can take forever to get a real person to pick up the phone and when someone does, they too often provide incorrect information or can’t resolve the problem. Many people with Medicare rely on the customer service reps and salespeople of the Medicare private drug or health plan, but information from them is also unreliable. It is tailored to suit the company’s interests, not those of the consumer.
We need a better system for educating people with Medicare about their coverage options and counseling them when they run into trouble. In a report released this week, the Medicare Rights Center makes four key recommendations:
- Congress and the Administration must standardize Medicare private health plans (also known as “Medicare Advantage” plans) and drug plan choices to allow people with Medicare to make informed choices and eliminate wasteful spending;
- The Centers for Medicare & Medicaid Services (CMS) must revise its organizational structure and create a new office that is attuned to and accountable for meeting the educational and counseling needs of people with Medicare;
- CMS must harness the experience and resources of community and advocacy organizations, including State Health Insurance Assistance Programs (SHIPs), and better equip them to serve people with Medicare; and
- CMS must move toward greater use of dynamic, interactive web-based education and counseling resources, and reduce dependence on the 1-800-Medicare telephone hotline.
It is time for the new administration to refocus CMS’s energies on giving consumers consistent and reliable information to make coverage choices and on providing one-on-one assistance when they need help accessing health care.
“CMS’ current model for providing consumer education couples an overly complicated market for Medicare Advantage and prescription drug plans with reliance on poorly equipped 1-800-Medicare operators to help guide consumers’ choices.” (Proposal to Restructure and Improve Counseling and Education for Medicare Consumers, Medicare Rights Center, March 2009)
“Based on previous experiences in the Medicare Advantage program, we believe that multiple plan offerings by Medicare Advantage Organizations may not result in beneficiaries choosing a plan which best suits their health care needs, but can, instead, confuse beneficiaries. Additionally, we are concerned that the current multitude of Medicare Advantage plan offerings may conceal aspects of a plan, such as high cost-sharing for certain services, which are not advantageous to beneficiaries.” (Draft 2010 Call Letter, CMS, February 2009)
“Turn to Medicare Interactive—your one-stop source for information about your health care rights and benefits.” (Medicare Interactive, Medicare Rights Center, 2009)
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Medicare Part D Appeals Help for Advocates Is Here!
Medicare Rights Center’s new Medicare Part D Appeals: An advocate’s manual to navigating the Medicare private drug plan appeals process offers an easy-to-understand, comprehensive overview of the entire appeals process, including real-life case examples, a glossary of important appeals terms, a sample protocol for advocates, and links to important resources.
Register for a FREE copy of this great resource.
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Medicare Part D Monitoring Project
would like to hear about your experience, or that of someone you know, enrolled in a private drug plan. With information about what the issues are with Medicare Part D, we will be able to demand that those problems be fixed. Medicare Rights Center
Submit your story at http://www.medicarerights.org/issues-actions/tell-your-story.php.
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The Louder Our Voice, the Stronger Our Message
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Asclepios—named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
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The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives.
Visit our online subscription form to sign up for Asclepios at http://www.medicarerights.org/about-mrc/newsletter-signup.php.
Get answers to your Medicare questions from Medicare Interactive at http://www.medicareinteractive.org.