Enrolling in a Medicare prescription drug plan? You’ll need extra time, advocates say

Sep. 29--A new online Medicare Plan Finder tool could make it more time-consuming and difficult for seniors to research and enroll in a Medicare prescription drug plan this year, advocates say.

"I have people on the margins," said Julie Hine, a prescription analyst for the Senior Benefits Group, which is a state-licensed independent insurance broker and works with about 7,000 people each Medicare open enrollment period.

Some of them are seniors who are homebound. Others don't have Internet access. She recalled one man who makes his prescription drug list on the back of a previously used envelope to save money on paper.

"That's perfectly good paper," she said. These are people for whom every penny matters.

"Last year, we saved one person $14,728 by changing their prescription coverage," she said. "We have other clients, you know, you save them $80 for the year and they're excited."

Hine is worried about some of the more vulnerable seniors having to make impossible choices between food and medicine because they might not be able to navigate the new Medicare Plan Finder to make the best decisions about their prescription drug plans.

The Centers for Medicare & Medicaid Services (CMS) first introduced the new system in late August, and has been tweaking it since its introduction. The old system will be completely shut down and replaced with the new Medicare Plan Finder on Oct. 1.

This change is happening two weeks before Medicare open enrollment begins Oct. 15. That's when millions of people ages 65 and older must choose a prescription drug plan for 2020 before the enrollment window closes Dec. 7.

While many advocates agree that updates to the old Medicare Plan Finder were needed, as it appears now, the new system doesn't total monthly out-of-pocket costs to include co-pays and deductibles. Users have to do the math on their own. It also doesn't have the same sorting features as the old plan, making it more difficult to find restrictions, see lowest-cost plans, sort and compare prices at pharmacies that are preferred by the plan, Hine said.

In Michigan, about 20% of people, or 1 in 5, will be faced with Medicare decisions this open enrollment period, said Jo Murphy, who is executive director of the Michigan Medicare/Medicaid Assistance Program, which contracts with the state's 16 Area Agencies on Aging to help Michigan's seniors navigate the Medicare system.

It's tedious and complex work because each possibility is complicated by whether the person uses mail-order, in-network, or out-of-network pharmacies, drugs that are not on a particular plan's formulary, preferred and generic vs. brand name medications, deductibles, co-pays and more.

"Details matter," Murphy said. "They cost people money, and this is people's health care that we're talking about. We save the residents of Michigan millions of dollars every year in money that they would have had to pay because they didn't know the right decision to make or they didn't get help getting a problem straightened out."

Hine agreed, adding: "Every time someone goes into a nursing home that uses a long-term care pharmacy, somebody needs to do an evaluation to make certain that the long-term care pharmacy is an in-network pharmacy for the plan that's selected. Otherwise, the family's paying out of pocket for the medication.

"Who is advocating for these people? We are."

It's people like Hine and State Health Insurance Counseling & Assistance Program (SHIP) counselors who work for Murphy's nonprofit program and other senior advocacy groups who are losing sleep over the changes the new Medicare Plan Finder that might make their work harder, and could force them to turn away seniors who need help this year because they just couldn't get to everyone within the open enrollment period.

That's why the National Council on Aging and others are urging seniors to call to schedule appointments with a Medicare counselor early to ensure they get the help they need.

"Don't wait," said Ann Kayrish, senior program manager for Medicare at the National Council on Aging.

For seniors who opt to enroll on their own using the Medicare Plan Finder themselves, she urged them to allow plenty of time to use the new website, learn how it works early in the the open enrollment period, so if problems arise, there's still time to get help.

The population eligible for Medicare is generally less tech-savvy than younger Americans and also less connected, the Pew Research Center said in a 2017 report about tech adoption among older adults.

One-third of adults ages 65 and older said that they never use the Internet. About half said they don't have home broadband Internet service, and the proportion of seniors who own smartphones is 42 percentage points lower than those ages 18-64 who said they do.

And among the seniors who do have Internet service, Pew reported: "Some 34% of older Internet users say they have little to no confidence in their ability to use electronic devices to perform online tasks, while 48% of seniors say that this statement describes them very well: 'When I get a new electronic device, I usually need someone else to set it up or show me how to use it.' "

If seniors feel overwhelmed trying to use the new system, don't have Internet access or have questions or concerns, Kayrish said they should call a Medicare counselor in October to get an appointment early in the Oct. 15-Dec. 7 open-enrollment period.

"Those that use SHIP counselors, get your appointment earlier than later," she said. "There's only so much time during open enrollment. And because each appointment is going to take longer, there is a chance some people won't be seen."

Murphy said she's encouraged to see that CMS has been taking concerns of the counselors who work with seniors seriously, and has been updating the new plan finder continuously since late August.

"It was designed for the general public," she said. "It's much cleaner. But in the whole design process, some of the things that were there before got lost. This is what happens when you change systems.

"In fact, as we're speaking, it's not finished. ... We gave feedback, and suggested some changes, and they made those changes.

"We keep submitting complaints. We can submit it every day, and I have nearly every day seen changes. So they are continually working on it. There are some bigger things that are important, and they have prioritized those."

For example, Murphy said CMS has given assurances that the function that shows total monthly out-of-pocket costs for each prescription drug plan will be added to the system by Oct. 1.

"We are all waiting anxiously for Oct. 1," she said. "At this point, I know every little thing people may want there will not be there, but I am feeling comfortable the little things that are really important will be there. I can log on every day and it will be different."

But that adds to the difficulty in training her staff. She wishes there had been more time to smooth out the bumps.

"It's been a very difficult transition, partially because it's been a late rollout," Murphy said. "I have 700 people in the state of Michigan who need to be trained. I would have liked to have been able to start that training earlier. And even today, we have to say here's what we know right now because it's continuing to change."

And that makes the timing of this change especially problematic.

"Buckle up," said David Lipschutz, associate director of the Center for Medicare Advocacy. "The fact that very little time was given for counselors to test, troubleshoot and get used to the new plan finder prior to open enrollment, which starts on Oct. 15," is going to make for a rocky transition.

There won't be overlap of the old and new Medicare Plan Finder systems during the Oct. 15-Dec. 7 open-enrollment window, either, Lipschutz said. On Oct. 1, the old system will disappear.

"This update seems to be motivated, in large part, by a change in federal contractor," he said. "There's one federal contractor that has the old plan with a contract that's expiring next week. So on Oct. 1, a new contractor takes over."

Some of the functionality of the old system will be lost when that happens, such as the ability to save a list of prescription drug plans that has been tailored to an individual's medications without having to use personally identifying information, such as a Medicare number. Instead, every senior will need to create a My Medicare account to save a drug list.

For seniors without home Internet access or smartphones, Hine said, this could be a problem because many of them have no clue how to create a My Medicare account, and don't even have a valid email address to link to such an account.

These challenges will make it more time-consuming for counselors who work on behalf of large numbers of seniors to help them narrow down the Medicare prescription drug plans that are going to be the most cost-effective, said Casey Schwarz, senior counsel, education & federal policy for the Medicare Rights Center, a national, nonprofit consumer service organization.

"The burden on these folks (high-volume users) was not well considered and not well planned-out and that is a problem," she said. "We want to be really clear that the inability to save an anonymized search and not be able to go back to it has a real impact on high-volume users and will create a situation where they can help fewer people. That's a real problem. I don't want to minimize that ... but the burden is not going to be a burden to an individual user.

"I think CMS did some good beta testing. The decision tree aspect of it, the way questions appear one at a time, all of those things are actually much easier for people who have never done this or who have only done this once or twice.

"But because this is a departure from what people have known, people who may have developed their own shortcuts and ways around the clunkiness ... someone who has used the old system is going to find this more confusing than someone who doesn't use the old system."

Lipschutz said his organization is concerned that the new plan finder's requirement to use a My Medicare account to save a drug list gives too much personal health data to third-party counselors, some of whom could use their private health information for unscrupulous things.

"This tool that's being touted by agents and brokers to securely import data directly from the Medicare.gov website, including prescriptions filled, pharmacies used, and health care providers utilized, there's significant concern that such information could be abused, and that could be used to either steer people toward or away from certain plans. These issues CMS has not addressed adequately, in our view.

"As added kind of backdrop, these changes to the Medicare Plan Finder are happening at a time when there are some pretty significant changes on the Medicare policy level that go into effect in 2020. And that includes the expansion of what Medicare Advantage plans can provide with respect to supplemental benefits."

Sherrill Heinrichs, 71, of Bloomfield Township, said it's unsettling.

She works in congregational care at Northbrook Presbyterian Church in Beverly Hills, where she helps members with various life challenges -- whether they're young, old or in between.

Heinrichs was looking at the new Medicare Plan Finder earlier this week and was baffled by some of the changes.

"Some medications have been deleted, and some are going up in price," said Heinrichs. "I ran into a problem right away with one of my meds, which is an antibiotic because I had double knee replacement. I have to have antibiotic whenever I need dental work. I need four amoxicillin three times a year. There is no way to put it in the site. You have to do one pill a month for 12 months. It doesn't accept what I need.

"It's frustrating and it's like anything else, it might be easier for some people to do but for our seniors, we need help."

Heinrich said she had lunch recently with many of the older congregants at her church and warned them to get started soon on choosing a new plan.

"I explained to them what is going on and that they needed to be very careful if they went online," Heinrichs said. "With the old plan finder, you could do it by yourself and it works. The new one, it doesn't seem to work right, and it doesn't give you the same options that you had before.

"It's very hard. Why they are making it more complicated for seniors, I don't know. ... If people don't know where to go for help, they really are stuck. They are going to be paying a lot more."

Heinrichs said she called her local Area Agency on Aging-1B to set up an appointment with a Medicare counselor to figure out what's best for her, but her appointment isn't until November.

Hine said that for older men and women who've been working with her company for years, there's a feeling of personal responsibility to ensure they're getting a prescription plan that fits their needs.

"They call us when their spouse had surgery and they get invoices that they don't understand," she said. "We help them look at their Medicare summary notices to figure out what's allowable and what needs to be re-billed or any time they have an issue there.

"They're coming to us. I'm just concerned about Delores and Gertrude and Beatrice -- all the names that are gone from the kindergarten rolls.

"My heart is breaking for our seniors."

Contact Kristen Jordan Shamus: 313-222-5997 or [email protected]. Follow her on Twitter @kristenshamus.

How to get Medicare help

To speak to a Medicare counselor through the State Health Insurance Assistance Program, call 800-803-7174.

The new Medicare Plan Finder can be found online at https://www.medicare.gov/.

Tips for this year's Medicare open enrollment

Open enrollment runs Oct. 15-Dec. 7 to choose your 2020 Medicare health plans.

Advocates recommend that anyone enrolling in a Medicare prescription drug plan should:

-- Check out the new online Medicare Plan Finder early. It will replace the old website on Oct. 1. You can find it at: https://www.medicare.gov/

-- Create a My Medicare account at https://www.mymedicare.gov/.

-- If you have trouble or need help, call Medicare's 24-hour helpline toll-free at 800-Medicare (800-633-4227).

-- If you need help comparing plans and enrolling, you also can call a free counselor at the State Health Insurance Assistance Program at 800-333-4144. Or call an established Medicare insurance agent. It's best to schedule an appointment now for later in the month or November. Advocates urge seniors not to wait until December to make an appointment.

-- Give yourself time to really think about what prescription drug plan best fits what you need.

-- Keep in mind that just because a prescription drug plan worked great for you in the past doesn't mean it's the best plan for you in 2020. Most plans have changed what they will offer in the year ahead.

-- Resist the urge to be lured by a low premium alone. The best plan is one that covers the drugs you take without restrictions like prior authorizations or quantity limits, that could impair your access to your medicine.

-- Check out the formulary on the website of each plan you're considering. You'll really have to dig into the plan details to determine whether the drugs you take are covered by each plan, know the restrictions, step therapy, quantity limits.

-- The change is going to require more effort. Be sure you're designating more time during open enrollment to be confident that your're picking the plan that's right for you.

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