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Making Medicare choices in a marketplace mess: emperor wears no clothes

Making Medicare choices in a marketplace mess: emperor wears no clothes

November 19, 2018

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Gary Schwitzer is the writer and founding father of  He tweets as @garyschwitzer.

Good luck sorting via these things

In case you’re 65 or older, you could be in the center of a Medicare decision-making mess proper now as a result of it’s open enrollment time.

When you’re youthful than 65, all I can say is “Good luck when you get to this point.”

I’ll be on Medicare for the primary time in about a month and a half.  I’ve coated well being care subjects for 45 years, though not fairly often on Medicare points.  Nonetheless, I’m in all probability extra tuned in than most individuals I do know.  Regardless of this, I can inform you that sorting by way of the Medicare “marketplace solutions” as some euphemistically name them – to buy protection for what Medicare doesn’t cowl – has been maybe probably the most complicated and irritating shopper expertise of my profession.

“You’re not alone in being confused,” says contributor and long-time journalist Trudy Lieberman.  She wrote “Don’t Touch My Medicare!” for Harper’s Journal in 2016. “The program is complicated, hard to understand and tailor-made for misleading and deceptive sales practices that have plagued the marketing around this program from the very beginning. Where those practices once were confined to the marketing of Medigap policies, they’ve now spread to the sales of Medicare Advantage plans, the private market alternative to Medicare. Those coming on to the program and even people who’ve been on it for years need all the help they can get.”

Minnesota’s mess

It could be particularly acute for my spouse and me as a result of we stay in Minnesota, one of many final states to nonetheless supply so-called Medicare value plans.  (Medicare studies that presently, 15 U.S. states have counties that provide Medicare value plans, that are described as a hybrid – a cross between a Medicare complement and a Medicare Benefit plan.) However most such plans are being eradicated in Minnesota this yr.  So I’m unfortunate sufficient to be signing up for Medicare in a yr and in a state with greater than 300,000 prior value plan subscribers pressured to modify over to a different plan.

That is one time I want native journalism might have helped me type by means of all of this.  However it hasn’t – in my view, a basic instance of native journalism that isn’t in contact with the group it serves.

Lieberman has coated well being coverage points – and critiqued journalism about well being coverage – longer than anybody I do know. She wrote to me:  “I have not found any excellent reporting this open enrollment season.  So if you’re looking for great work, there isn’t any. It’s all very depressing given how confused people are about the program based on the emails I received.”

Prime 10 issues I’ve noticed – the place is journalism on these points?

  1. If that is what represents a marketplace answer to Medicare, we’re all screwed.
  2. Insurers are overwhelmed and completely unprepared to cope with the quantity of shopper questions.
  3. No insurer info supply has been useful.  We’ve been to insurer seminars, to an unbiased Medicare dealer or agent, to insurer web sites, to insurer “help” (ha!) telephone strains, and to insurer retail facilities.  We’ve persistently requested easy questions that no one can reply.  We went to at least one insurer workshop the place the younger saleswoman didn’t know what the phrases HMO, PPO, POS truly meant – all acronyms she was throwing round in her gross sales pitch.  Worse, we have now been given blatantly inaccurate info a variety of occasions from a variety of insurance coverage firm sources.
  4. We went to at least one insurance coverage firm “information session” that had no less than 200 attendees.  I studied faces in the massive room.  I sensed confusion, despair, submission to one thing that was out of their management. There have been so many individuals there that the insurance coverage firm determined to not have a question-and-answer interval.  So there was a firm gross sales speak and slide present and a few supplies have been handed out.
  5. We made an appointment with one “independent” Medicare dealer/agent.  We gained’t make one other.  She clearly didn’t know sufficient to offer us correct, balanced, full recommendation.  She despatched us house with literature from only one insurance coverage firm – one we gained’t select.  Such brokers supply free recommendation periods; they’re paid by whichever insurance coverage firm the shopper ultimately chooses.  This dealer gained’t make any cash from our go to.  She didn’t earn it. What number of extra like her are on the market proper now giving biased, less-than-fully-informed recommendation?  Native journalists ought to sit in on a few of these dealer/agent periods.
  6. Insurers supply too many choices too poorly outlined.  Advertising materials from totally different insurers use totally different phrases – avoiding the acknowledged labels for the 2 most important choices –  a Medigap complement plan or a Medicare Benefit plan – in favor of “Discover Plus…Discover Grand…Discover Elite…Freedom….Gold…Premier…Signature Solution…Choice…Value.”
  7. There’s a clear bias for and benefit given to Medicare Benefit plans.  In Minnesota alone, an estimated 125,000 individuals whose Medicare Value plans are going away have been mechanically re-enrolled in Benefit plans whether or not they comprehend it or not.  Meantime, buddies and neighbors whom I talked with have been accepting this re-assignment unquestioningly.  If you wish to see an instance of the saying “clear as mud,” learn the Middle for Medicare & Medicaid Providers’ rationalization of Benefit plans.  In case you are in the competing Medigap complement plans, you need to work to seek out info as a result of there’s such a clear bias towards steering individuals into the Benefit plans.
  8. My spouse and I are blown away fascinated by the sum of money and assets we’ve got seen wasted on unhelpful advertising communication.  Junk mail advertising items from insurers in our mailbox every single day, numerous gross sales seminars run by uninformed salespeople, numerous employees behind the scenes scrambling to enroll new subscribers, a number of massive colour advertisements in the newspaper each single day.  We’re struck by how a lot cash is being spent – and none of it to immediately enhance seniors’ affected person care.
  9. I’ve requested individuals my age what they’re selecting – associates, neighbors, individuals on the health club the place I work out.  The solutions I get again virtually universally exhibit a deep misunderstanding of the plans, what they symbolize and what they don’t.
  10. My native Star Tribune newspaper has written about 10 tales about Medicare open enrollment this Fall. So it’s not that they’ve ignored the difficulty.  However the tales are sometimes repetitive, with mind-numbing statistics, superficial,  include interviews with the identical sources, impersonal, with little shopper enter. One story led with this: “Anxiety, frustration and hints of exasperation are all in the mix as more than a quarter-million Minnesota seniors face the prospect of selecting new Medicare health plans in the coming months.”  That very same story interviewed two Medicare shoppers who have been quoted for a complete of 48 phrases. Within the 10 tales I’ve seen, there was just one different shopper quote.  I’ve seen quotes, reminiscent of this from a Middle for Medicare Advocacy lawyer: “If you step back, really, isn’t this situation absurd? How is anyone supposed to be able to navigate all this?” However I haven’t seen any unbiased evaluation to information shoppers.  As I’m scripting this, the Star Tribune lastly touched on a number of the points I want have been coated extra typically, extra deeply in a story: Minnesotans interact the Medicare v. Medicare Benefit debate.  However even that was not an “enterprise” story, however solely a response to a journal article.  For a lot of readers that is too little too late.  One insurance coverage firm we referred to as final week to make an appointment for recommendation doesn’t have any openings till mid-December.  My insurance coverage expires December 31.  So we’re proper again in the quagmire of ineffective telephone calls, ineffective info periods that don’t adequately inform, and ineffective web sites.  

Lieberman, who has heard greater than 100 gross sales pitches for her tales on Medicare, says what my spouse and I discovered is all too widespread. As an alternative of counting on uninformative and maybe even misleading gross sales pitches, she recommends that buyers search assist from their Medicare state medical insurance help program or SHIP. They’re obtainable in each state and she or he says they “give the best advice around.” She wrote to me: 

Reporting on Medicare has been scarce this open enrollment season. There have been a few tales right here and there noting that folks have choices to make this yr however they didn’t all the time clarify what these choices are.  A great how-to Medicare story ought to observe these three factors:

1) Not a lot is understood about how seniors in Medicare Benefit plans fare once they have a actually critical sickness.  In late September the Workplace of the Inspector Common introduced that Benefit plans could also be inappropriately denying providers to seniors and requested Medicare to enhance its oversight. The Inspector Basic reported the plans overturned 75 % of their denials, elevating questions on why they have been denying care in the primary place. The Inspector Basic’s workplace stated it was involved as a result of seniors could also be denied providers however don’t register any complaints.

2) Individuals new to Medicare and purchasing for a plan typically don’t know that the one time they will purchase a Medigap coverage with out regard for his or her preexisting well being circumstances is usually throughout their preliminary eligibility interval, often the primary six months after signing up for Half B. Solely New York, Massachusetts, Connecticut and Maine permit seniors to purchase a Medigap coverage any time. 

three) Store in your prescription drug profit and use the drug plan finder on Individuals can save lots of of dollars a yr by buying rigorously for the drug profit.

The emperor wears no clothes

We will now see that bare fact. The Medicare marketplace answer is a fantasy. The wasteful spending that we have now seen allotted to unhelpful advertising, and to bloated staffing that also can’t reply shopper questions, is unbelievable till you see it for your self.

Mixed, my spouse and I’ve labored in and round well being look after almost 100 years.   We’re above common on a scale of being well-informed.

Our recommendation:  truthfully, we will’t give any.  This has been probably the most complicated shopper expertise we’ve ever confronted.  We’ll make a selection, figuring out that we don’t have 100% confidence in that selection, and crossing our fingers.  Which is a shaky proposition for a couple that has labored their entire lives to get thus far of retirement.


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