By Philip Moeller
If it’s hard for health care journalists to keep up with Medicare’s flood of announcements about new and revised programs, imagine what it must be like for the poor consumers who actually have to use Medicare.
In fact, Medicare’s complexity has been identified in research as a significant deterrent to broader consumer use of the program’s wide range of benefits. Even though Medicare has an open enrollment period each year that basically amounts to a free “do over” for consumers, seniors can be so intimidated by the process that they just stick with what they have even if it’s inferior to other options.
With this in mind – and having spent the past two years answering reader’s Medicare questions for PBS NewsHour – here are 10 items (and, yes, this is a made-up number for the list gods) that health care journalists might like to know as they shape their plans for Medicare coverage:
- There are a half-dozen different Medicare enrollment periods. Enrolling late can trigger steep lifetime financial penalties and even leave people with no insurance for extended periods. Make sure you’re specific when writing about enrollment periods.
- As long as people have active group health coverage from employers with more than 20 employees, they do not need to sign up for Medicare when they turn 65 or, indeed, at any age.
- The complexity of health insurance decisions has been hidden from most consumers who have employer plans. So they’re hit them full force when they enroll in Medicare and now must make more coverage decisions for themselves.
- Most people mistakenly believe Medicare covers long-term custodial care. It does not. Nor does it cover routine dental, vision, and hearing expenses, although some Medicare Advantage (MA) policies do.
- Consumers have guaranteed access to Medigap (also called Medicare supplement) insurance and cannot be underwritten for pre-existing conditions. But these rights exist only during their initial open enrollment period. If they attempt to buy or switch Medigap policies once this window has closed, they may be charged much higher rates or denied coverage altogether. And disabled Medicare users who have not yet turned 65 have no guaranteed access to Medigap in roughly half the states.
- Health care provider networks in MA plans are poorly understood by consumers and not well regulated by the Centers for Medicare & Medicaid Services (CMS). This will make for many great stories for you but equally unpleasant times for many consumers.
- Every Medicare beneficiary has a personal health risk score that determines how much the government would pay private insurers for their care. Consumers don’t know and can’t even find out this score. I bet you can’t, either. Check out Fred Schulte’s great coverage of this topic.
- Medicare’s catastrophic drug coverage, provided in Part D plans, is mostly a catastrophe for taxpayers. Medicare legally is prevented from negotiating drug prices with pharmaceutical companies. Yet it is legally required to pay 80 percent of the costs of expensive drugs. Not surprisingly, pharmaceutical companies exploit these rules, which they helped put in place when Part D plans were created in 2003.
- Consumers tend to have no clue about all the Medicare trial programs coming their way – bundled payments, accountable care, fee-for-outcome payment tests, and the like. Reporting on the technical and policy provisions of these programs is hard enough, but your stories also should help prepare Medicare beneficiaries for life in this brave new world.
- End-of-life physician counseling, expanded hospice, death-with-dignity, and related programs will have enormous impacts on the care that Medicare beneficiaries choose to receive and the cost of that care. This is where the rubber will meet the road so far as an aging America is concerned.
Special offer for AHCJ members:
Moeller’s new book, “Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs.” will be released on Oct. 4. The publisher, Simon & Schuster, will send a review copy to interested journalists. Send an email to Marketing@simonandschuster.com with “Get What’s Yours for Medicare – Special Offer” in the subject line and include a physical address, or a note if you’d prefer an ebook copy. The offer is good until Oct. 31, 2016.
Resources:
- CMS provides a firehose of news and data. You just need to know where to find it. The agency’s Internet-only Manuals (IOMs) are a great, if not easy-to-master, resource.
- State Health Insurance Assistance Program (SHIP).
- Medicare Rights Center.
- Center for Medicare Advocacy.
Philip Moeller (@PhilMoeller) writes about senior health and related issues for the PBS NewsHour and Money. He co-authored a New York Times Bestseller about Social Security last year, and has a new guide to Medicare being released in early October.
