Monday, December 22nd, 2014

The Obameter

Provide easy-to-understand comparisons of the Medicare prescription drug plans


"An Obama administration will require companies to send Medicare Part D beneficiaries a complete list of the drugs the individual used the past year as well as the pertinent fees paid the previous year. Companies will also be required to provide seniors with online versions of this information, so that they can use it at a third-party comparison shopping site, similar to Priceline.com."


Updates

Drug plans are easier to compare

On the campaign trail in 2008, Barack Obama promised to make Medicare prescription drug plans easier to understand and compare.

Seniors who qualify for Medicare can get their medications covered by private insurance companies that contract with the government. Under Medicare Part D, private insurers only cover prescription drugs, whereas with Medicare Advantage, insurers cover the traditional benefits of Medicare, plus prescription drugs. In both cases, the plans vary in the price of premiums, annual deductibles, co-payments, lists of covered drugs and participating pharmacies, each of which can change from year to year.

As a candidate, Obama said "seniors have been deluged with massive amounts of information about the various plans, but have received little guidance about which plans actually suit their unique needs.” He outlined his vision for a "comparison shopping site, similar to Priceline.com.” The website would allow seniors to pick the least expensive insurance plan that still covered their prescription drug needs. Obama also said he would require insurance companies to provide a complete list of drugs the person used in the past year, along with any associated fees.

Since 2006 the Centers for Medicare and Medicaid Services have maintained and periodically updated an online tool called the Medicare Plan Finder, which allows people to compare prescription drug plans. Today's version asks for seniors' ZIP code, medications and preferred pharmacy before producing a list of options. The software gives information about the relative costs and drugs covered by a range of local insurance plans, along with annual quality ratings assigned by the government.

"It's a very, very useful site,” said Jocelyne Watrous, who works for the Center for Medicare Advocacy, a group that defends the health care rights of seniors and people with disabilities. "It's pretty self-explanatory.”

Some businesses such as HealthPocket.com and eHealthInsurance.com also have websites that compare all types of prescriptions drug plans, including ones offered through Medicare.

Although the Medicare Plan Finder launched in 2006, it has experienced incremental improvements, especially in the last two years, according to Gina Upchurch, executive director of the North Carolina-based Senior PharmAssist, a nonprofit that helps local residents comb through Medicare drug plans to find the least expensive, most comprehensive option.

Upchurch said the quality star ratings attached to plans are more useful to seniors because they penalize plans with low ratings (two out of five stars) and create an incentive for insurers to achieve high ratings (five stars). The ratings are based on criteria such as customer complaints and the breadth of drugs covered by a plan.

The website is slightly more user friendly now, Upchurch said. It used to crash frequently and for long periods of time (it doesn't now), it has several new sorting options and an instructional YouTube movie that walks seniors step-by-step through the plan finder tool.

Obama's pledge also mentioned that insurance companies should send information to seniors about their current coverage. Watrous, of the Center for Medicare Advocacy, pointed out that Medicare requires insurance plans to send customers a monthly explanation of their benefits. These monthly summaries detail the drugs the customer has taken, the cost of those drugs, who paid what proportion of the cost and the person's stage of coverage -- including the gap in coverage commonly known as the donut hole. In addition, Medicare requires an annual report about the plan, drugs covered and the cost, along with an annual notice about changes in the plan.

As a candidate, Obama sought to provide easy-to-understand comparisons of Medicare drug prescriptions plans. Several free websites provide that service, including one by the federal government, which improved under his watch. For this, we rate this a Promise Kept.

Sources:

The Associated Press, Expect changes in drug co-pays for Medicare, Nov. 4, 2008 (subscription)

Centers for Medicare and Medicaid, Medicare's 2012 open enrollment drug and health plan data goes live Saturday, Oct. 1, Sept. 30, 2011

Interview with Jocelyne Watrous, Medicare Advocate for the Center for Medicare Advocacy, Nov. 30, 2012

Interview with Gina Upchurch, executive director of Senior PharmAssist, Dec. 5, 2012

Email interview with Marie Cocco, spokeswoman for the Blue Cross and Blue Shield Association, Dec. 5, 2012

Health bill addresses Medicare prescription drug plans

President Barck Obama promised to simplify the way seniors buy prescription drugs through Medicare. Health reform legislation in the Senate would try to accomplish that.

The Senate Finance Committee released its proposal for health reform on Sept. 16, 2009, and it calls for the secretary of Health and Human Services to develop standards for simplifying Medicare Part D, which is the prescription drug plan.

The secretary would be required "to develop standardized nomenclature, definitions and language to describe and present the benefit categories on the Part D plan finder and in other relevant beneficiary communications. For example, the secretary could establish three categories of benefit levels — Bronze, Silver and Gold. Plans would be required to indicate the benefit category of each plan in the name of the product. The secretary would also be required to ensure that there are meaningful differences between the benefit categories."

That's a measurable step in the direction toward easy-to-understand comparisons of the Medicare prescription drug plans. It doesn't mention some of the details of Obama's proposal, but it is enough to move the meter. We rate this promise In the Works.

Sources:

U.S. Senate Finance Committee, Chairman's Mark: America"s Healthy Future Act of 2009 , Sept. 16, 2009