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The Government Wants Seniors Out of Bad Medicare Plans

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Even though open enrollment closes this week for some 47 million seniors who can change their Medicare coverage arrangements for next year, the federal government is extending the deadline for certain people. Who are the lucky ones?

Seniors who find themselves with a poor or below average drug plan or a similarly deficient Medicare Advantage plan—plans that have earned fewer than three stars on Medicare’s star rating system for three years in a row—have more time to make a change. Medicare wants consumers out of these plans so badly that it has sent personal letters this fall to some 525,000 beneficiaries advising them to change plans, and it is letting them do that once during the coming year providing they choose a plan that merits three stars or better.

What do these star ratings tell us anyway? The Centers for Medicare and Medicaid Services, CMS, says that Medicare Advantage plans are rated on five dimensions: keeping people healthy with screenings and tests, managing chronic care, member satisfaction with the plan, complaints and problems getting services, and the plan’s customer service.

For drug plans, customer service, member complaints, and satisfaction are in the ratings mix but so is patient safety and accuracy of drug pricing. These measures are supposed to identify better plans that CMS says give “better care and value.” A five star “excellent” plan does a better job on these measures than a three-star “average” option, the government says.

The question is: if these plans—26 of them—are performing so poorly, why doesn’t the government just shut them down? Why make consumers go through the work of selecting a new plan when, if CMS wanted to, it could simply say they couldn’t sell any more new business? CMS has a range of sanctions ranging from warning letters to the tough stuff like terminating the plan’s contract with the agency. It looks like they are going easy on them for now, pushing seniors to make the first move.

As I learned last year when I signed up for Medicare, the task of selecting a plan to cover Medicare’s coverage gaps is not easy and far from straightforward. Thinking things might have changed, I tried to look at plans—the good, bad, and the middling—on the government’s website, and found it as difficult as ever to navigate. After about 30 minutes, I gave up and never reached the pages for the Medicare Advantage plan options. The site kept bouncing me back to the drug selection menu.

This year, the Medicare handbook was even less useful since it gave no star ratings for the plans. If there were any poor-performing plans in New York City in 2012, I would never know it unless I had the patience to tackle the website again or wait for a CMS press officer to send me a list.

The handbook did offer a snippet of data about quality. Shoppers could learn the percentage of customers who rated their plan the best. Apparently this was a gussied up way of presenting satisfaction ratings without saying so, but the term was meaningless. Best compared to what, I wondered.

Seniors usually have only one plan, so were they comparing their plan to one they may have had in the past? For most plans, the percentages of people who rated their plans the best clustered in the low 80s. What’s a consumer supposed to do with information that says 84 percent of members rated their plan as the best but at another plan 82 percent did? Practically speaking, most will do nothing with it.

Time will tell whether the half million Medicare beneficiaries will leave their poor performing plans or will stay put until the government closes them down—if it does. Earlier this year, a report from the National Bureau of Economic Research, a private nonprofit group, showed that seniors rarely switch plans even when they might get one with a cheaper premium. Other factors like restrictions on drugs or whether their doctors are in the plan may trump price, meaningless satisfaction ratings, and yes, the government’s stars. Perhaps the shopping process CMS has set up is just too darn hard.

More Blog Posts by Trudy Lieberman

author bio

Trudy Lieberman, a journalist for more than 40 years, is an adjunct associate professor of public health at Hunter College in New York City. She had a long career at Consumer Reports specializing in insurance, health care, health care financing and long-term care. She is a longtime contributor to the Columbia Journalism Review and blogs for its website, CJR.org, about media coverage of health care, Social Security and retirement. As a William Ziff Fellow at the Center for Advancing Health, she contributes regularly to the Prepared Patient Blog. Follow her on twitter @Trudy_Lieberman.


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strieger says
December 5, 2012 at 3:50 PM

I am amazed that a college professor and journalist cannot navigate the Medicare drug finder. All you had to do was click the box that indicates I don't use any drugs, and you would have been moved to page that gave you the options on selecting either a stand alone drug plan or Medicare Advantage plans.



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