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

Gary Schwitzer is the publisher and founder of HealthNewsReview.org.  He tweets as @garyschwitzer.

Good luck sorting through this stuff

If you’re 65 or older, you may be in the middle of a Medicare decision-making mess right now because it’s open enrollment time.

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

I’ll be on Medicare for the first time in about a month and a half.  I’ve covered health care topics for 45 years, although not very often on Medicare issues.  Nonetheless, I’m probably more tuned in than most people I know.  Despite this, I can tell you that sorting through the Medicare “marketplace solutions” as some euphemistically call them – to purchase coverage for what Medicare doesn’t cover – has been perhaps the most confusing and frustrating consumer experience of my career.

“You’re not alone in being confused,” says HealthNewsReview.org contributor and long-time journalist Trudy Lieberman.  She wrote “Don’t Touch My Medicare!” for Harper’s Magazine 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 might be especially acute for my wife and me because we live in Minnesota, one of the last states to still offer so-called Medicare cost plans.  (Medicare reports that currently, 15 U.S. states have counties that offer Medicare cost plans, which are described as a hybrid – a cross between a Medicare supplement and a Medicare Advantage plan.) But most such plans are being eliminated in Minnesota this year.  So I’m unlucky enough to be signing up for Medicare in a year and in a state with more than 300,000 prior cost plan subscribers forced to switch over to another plan.

This is one time I wish local journalism could have helped me sort through all of this.  But it hasn’t – in my view, a classic example of local journalism that is not in touch with the community it serves.

Lieberman has covered health policy issues – and critiqued journalism about health policy – longer than anyone I 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.”

Top 10 things I’ve observed – where is journalism on these issues?

  1. If this is what represents a marketplace solution to Medicare, we are all screwed.
  2. Insurers are overwhelmed and totally unprepared to deal with the volume of consumer questions.
  3. No insurer information source has been helpful.  We’ve been to insurer seminars, to an independent Medicare broker or agent, to insurer websites, to insurer “help” (ha!) phone lines, and to insurer retail centers.  We have consistently asked simple questions that no one can answer.  We went to one insurer workshop where the young saleswoman didn’t know what the terms HMO, PPO, POS actually meant – all acronyms she was throwing around in her sales pitch.  Worse, we have been given blatantly inaccurate information a number of times from a number of insurance company sources.
  4. We went to one insurance company “information session” that had at least 200 attendees.  I studied faces in the large room.  I sensed confusion, despair, submission to something that was out of their control. There were so many people there that the insurance company decided not to have a question-and-answer period.  So there was a company sales talk and slide show and some materials were handed out.
  5. We made an appointment with one “independent” Medicare broker/agent.  We won’t make another.  She clearly didn’t know enough to give us accurate, balanced, complete advice.  She sent us home with literature from just one insurance company – one we won’t choose.  Such brokers offer free advice sessions; they are paid by whichever insurance company the client eventually chooses.  This broker won’t make any money from our visit.  She didn’t earn it. How many more like her are out there right now giving biased, less-than-fully-informed advice?  Local journalists should sit in on some of these broker/agent sessions.
  6. Insurers offer too many choices too poorly defined.  Marketing material from different insurers use different terms – avoiding the recognized labels for the two main choices –  a Medigap supplement plan or a Medicare Advantage plan – in favor of “Discover Plus…Discover Grand…Discover Elite…Freedom….Gold…Premier…Signature Solution…Choice…Value.”
  7. There is a clear bias for and advantage given to Medicare Advantage plans.  In Minnesota alone, an estimated 125,000 people whose Medicare Cost plans are going away have been automatically re-enrolled in Advantage plans whether they know it or not.  Meantime, friends and neighbors whom I talked with were accepting this re-assignment unquestioningly.  If you want to see an example of the saying “clear as mud,” read the Center for Medicare & Medicaid Services’ explanation of Advantage plans.  If you are interested in the competing Medigap supplement plans, you have to work to find information because there is such a clear bias toward steering people into the Advantage plans.
  8. My wife and I are blown away thinking about the amount of money and resources we have seen wasted on unhelpful marketing communication.  Direct mail marketing pieces from insurers in our mailbox every day, countless sales seminars run by uninformed salespeople, countless staff behind the scenes scrambling to sign up new subscribers, multiple big color ads in the newspaper every single day.  We are struck by how much money is being spent – and none of it to directly improve seniors’ patient care.
  9. I have asked people my age what they are choosing – friends, neighbors, people at the gym where I work out.  The answers I get back almost universally demonstrate a deep misunderstanding of the plans, what they represent and what they don’t.
  10. My local Star Tribune newspaper has written about 10 stories about Medicare open enrollment this Fall. So it’s not that they’ve ignored the issue.  But the stories are often repetitive, with mind-numbing statistics, superficial,  contain interviews with the same sources, impersonal, with little consumer input. 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 same story interviewed two Medicare consumers who were quoted for a total of 48 words. In the 10 stories I’ve seen, there was only one other consumer quote.  I’ve seen quotes, such as this from a Center for Medicare Advocacy attorney: “If you step back, really, isn’t this situation absurd? How is anyone supposed to be able to navigate all this?” But I haven’t seen any independent analysis to guide consumers.  As I’m writing this, the Star Tribune finally touched on some of the issues I wish were covered more often, more deeply in a story: Minnesotans engage the Medicare v. Medicare Advantage debate.  But even that was not an “enterprise” story, but only a reaction to a journal article.  For many readers this is too little too late.  One insurance company we called last week to make an appointment for advice doesn’t have any openings until mid-December.  My insurance expires December 31.  So we’re right back in the quagmire of useless phone calls, useless information sessions that don’t adequately inform, and useless websites.  

Lieberman, who has heard more than 100 sales pitches for her stories on Medicare, says what my wife and I found is all too common. Instead of relying on uninformative and perhaps even deceptive sales pitches, she recommends that consumers seek help from their Medicare state health insurance assistance program or SHIP. They are available in every state and she 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 stories here and there noting that people have choices to make this year but they didn’t always make clear what those choices are.  A good how-to Medicare story should note these three points:

1) Not much is known about how seniors in Medicare Advantage plans fare when they have a really serious illness.  In late September the Office of the Inspector General announced that Advantage plans may be inappropriately denying services to seniors and asked Medicare to improve its oversight. The Inspector General reported the plans overturned 75 percent of their denials, raising questions about why they were denying care in the first place. The Inspector General’s office said it was concerned because seniors may be denied services but don’t register any complaints.

2) People new to Medicare and shopping for a plan often don’t know that the only time they can buy a Medigap policy without regard for their preexisting health conditions is generally during their initial eligibility period, usually the first six months after signing up for Part B. Only New York, Massachusetts, Connecticut and Maine allow seniors to buy a Medigap policy any time. 

3) Shop for your prescription drug benefit and use the drug plan finder on Medicare.gov. People can save hundreds of dollars a year by shopping carefully for the drug benefit.

The emperor wears no clothes

We can now see that naked truth. The Medicare marketplace solution is a myth. The wasteful spending that we have seen allocated to unhelpful marketing, and to bloated staffing that still can’t answer consumer questions, is unbelievable until you see it for yourself.

Combined, my wife and I have worked in and around health care for nearly 100 years.   We’re above average on a scale of being well-informed.

Our advice:  honestly, we can’t give any.  This has been the most confusing consumer experience we’ve ever faced.  We’ll make a choice, knowing that we don’t have 100% confidence in that choice, and crossing our fingers.  Which is a shaky proposition for a couple that has worked their whole lives to get to this point of retirement.

 

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Comments (16)

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Paul Levy

November 19, 2018 at 8:01 pm

I had the same experience, Gary. Totally baffled, and that’s after 12 years in the industry. And shocked, like you, at the opacity of the process and the money wasted. And then I had to go through it again a year later when my PCP moved from a place that accepted Blue Cross Medicare Advantage to one that did not, that only accepted the Tufts Health Plan product.

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Ray Jones

November 19, 2018 at 11:24 pm

Humana,Aetna,FloridaBlue,nor Unitedhealthcare have my Dr in network, I am going to have to use original Medicare with a separate drug plan.

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Scott Maibor

November 20, 2018 at 4:58 am

I see what you describe every day. The system is a mess, poorly designed and confusing.
The only thing I can say is that as an Independent consultant the first thing I do with EVERY client is explain Parts A&B, what is covered and what is not. Then we review the pros and cons of Medicare Supplement Plans (with Part D) and the pros and cons of Advantage Plans. Once the client tells me which path they prefer I help them narrow down the list of options using a logical set of criteria (county, pop, meds, etc.).
Here in MA, as in MN we do it our own way so I can’t speak for the system in most other states personally.
I will say that due to Federal restrictions on speaking about Advantage plans (you actually need a Federal “permission slip” called a Scope of Appointment filed for 10 years!) there is much confusion about them.
SHINE counselors here in MA are not allowed to for instance as they are NOT AHIP (Medicare) certified and NOT licensed by the state to sell insurance which an Advantage plan is.
Lastly, while you had a bad experience with an Independent agent that perhaps does not represent everyone who does this. I once had a mechanic mess up an oil change but I still have my car serviced…just went to someone else!

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Patricia Kountz

November 20, 2018 at 6:09 am

We’ve tried 2 advantage plans. The first one said they were not going to pay a doctor because the primary care doctor didn’t refer my husband. After we changed that plan, Humana paid the doctor. We’ve been with AARP Medicare plan for several years and are impressed with their people. They are not perfect but we feel blessed.

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Jane W Milligan

November 20, 2018 at 6:48 am

Thank you. Its not just me. The frustration of trying to snorkel thru this swamp is unbearable

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CAROLYN FISCHER FISCHER

November 20, 2018 at 7:27 am

I’m 72 & have been going thru this now for 3rd time as they stopped my advantage fund due to “loss of $$”! I discovered that as u become older, health declines, they want more tests, Ct scans, etc that greatly > payments. So now, am going back w AARP. I, too, worked in healthcare & it doesn’t matter. We are all dumbfounded. They said old age isnt for sissies & they are SO RIGHT. I’d say get advantage plan ONLY if u have great health.
One more thing, WHEN will they ever put dental care on the map? We r all gonna die toothless.

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Paul Alper

November 20, 2018 at 10:52 am

Actually, Gary understated the situation. However, here is a tip: before signing on to a specific plan, check to see if your providers, medical and dental, are “in network.” But note that this does not guarantee said providers will remain “in network” throughout the plan year.
Here is a tip, at least for those of us in Minnesota: turn to page 65 of the 2019 version of Medicare and You:

“Starting in 2019, between January 1-March 31 each year, you can make these changes during the Medicare Advantage Open Enrollment Period.”

In other words, new for the year 2019 the consumer is not locked into a 12 month commitment. Frankly, I don’t see how this 2019 new arrangement ever was passed because this will lead to gaming the system: Pick a plan with a low monthly premium by the December 7 deadline in hopes that no medical intervention is needed and if expensive intervention suddenly arises within a month or two, switch to a different plan which has higher premiums but (much) lower costs for medical intervention.

As always there are details, but according to this official document, for the first time, the Medicare consumer is allowed to have a change of mind, a “buyer’s remorse.” But only once a plan year.

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Paul Alper

November 20, 2018 at 7:08 pm

I checked via the phone with a couple of medicare advantage suppliers about this new stipulation for 2019 which entitles one to a second enrollment period. One of the major outfits got it completely correct, two were wrong initially and one of them still has it wrong. As Gary indicates, the system is complicated and being an informed consumer is challenging.

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Barbara Zimmerman

November 20, 2018 at 11:36 pm

I always thought I could figure most things out or find the information I needed but like you finding correct information on medigap is impossible. The SHIP office in Iowa will only help with medicine plans not part B .

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Jeremy Engdahl-Johnson

November 25, 2018 at 9:17 pm

What are the basics and best practices to achieve Medicare Advantage star ratings – read more here: https://www.healthcaretownhall.com/?p=9051#sthash.QKsomhRl.dpbs

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Sandi Sherman

November 26, 2018 at 9:50 am

Thank you Gary. This article
captures exactly my experience and I too am a savvy “customer” when it comes to health insurance, having spent 10 years as an employee representative on the U of M’s Benefits Advisory Committee. I have had the same experience with phone help and brokers. I have listened to and watched other seniors struggle with all of this and just decide to go with whatever was recommended because it is too confusing. It’s criminal to do this to the most vulnerable population! I have been bounced to a different part D every year for the three years I have been on this in order to keep my expenses down, each time
having to change pharmacies to get preferred rates. I was on the BCBS cost plan at $145/month and loved it. No copays for anything and no referrals to the widest network there is. I chose to stay with them in a Medigap plan which is going to cost me $218 a month to get what appears to be the same level of benefits. It’s a crap shoot. If there was ever an argument for single payer this is it. Heaven help us if Medicare for all, as it is currently constituted, was implemented.

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Paul Alper

November 26, 2018 at 11:03 am

Some further checking: I found a knowledgeable sales person who said that until around 2006 it was possible to do switching of medicare advantage plans after the initial signup period. The resumption of a second enrollment period for the plan year 2019, according to her, is not just for 2019. Further, the intention is to reduce “buyer’s remorse.” Be sure to get all the details regarding ease of switching in the second enrollment period. I was told that as long as one switches plans within the same organization, the switch in the second enrollment period can be done over the phone. More involved if switching organizations in the second enrollment period.

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Aleta Kerrick

November 26, 2018 at 11:16 am

My husband & I have both turned 65 this fall. Your list of worthless-yet-expensive salesmanship by insurers omitted all the phone call solicitations. The only good thing about those has been that they create excuses for me to get off my tush and the computer to go answer the phone when I’m working from home. :-)

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Mimi Camp

November 27, 2018 at 10:10 am

While I share some of your experiences and concerns, I find that this report suffers from a one-state perspective. MN seems to have a unique issue right now that further complicates an already messy process. It is incredibly cruel that Medicare has become such a navigational nightmare for aging citizens who are losing their ability to cope with it! Still, having had very spotty insurance coverage for years before reaching 65, I welcomed Medicare. I used Medicare.gov as my primary source for understanding the basics–and it wasn’t easy! I persisted and eventually worked it out. The following year I was contacted by an very knowledgeable agent who was very low-key, and I got an Advantage plan. I have some philosophical doubts, but it has worked very well for me, and I especially like the dental, gym accesss, glasses credit, and OTC products benefits. They have added a hearing aid benefit this year, which is something I have to start thinking about and is a welcome addition. Now then, I should say that I think the reason I’ve experienced less difficulty than most commenting here is that I am in Wisconsin, a state with an almost universal HMO system. I get all my care from a regional medical center, so all my providers are in network and everything is covered. I have had no difficulty with anything and I have a number of chronic conditions. All surgeries have been covered and one brief hospitalization as well. As I am low income, I have a supplement from the state to cover most of my premium, for which I am truly grateful. It also reduces my prescription co-pays to an affordable level. All in all, this is the best coverage I have ever had. The stress of even getting access before 65, nearly killed me, so I cannot complain. After being downsized repeatedly, ending up in low pay, no benefit work, using up precious savings just surviving, I am fiercely denfensive of Medicare, although I loathe the politicians who have seen fit in their corruption to make it so mind-numbingly complicated!

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    Gary Schwitzer

    November 27, 2018 at 4:32 pm

    Mimi,

    Thanks for your note, and for acknowledging that your comment, too, reflects a one-person, one-state perspective. Frankly, I shudder to think of what the crazy quilt of individual or one-state perspectives might look like if we could reasonably tell such a story about open enrollment time information hurdles across the country.

    Gary Schwitzer
    Publisher

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Lee J. Siegel

December 1, 2018 at 7:04 pm

I have found AARP publications very helpful in figuring out what to buy. Also, my state, Oregon, publishes a great booklet that helps, listing lowest rates (urban nonsmoking female) for every Midicare supplement plan sold in Oregon: https://healthcare.oregon.gov/shiba/Documents/2019-medicare-guide-web.pdf

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