Medicare beneficiaries find enrollment in some of its programs, such as Part B, confusing and may struggle to pay for medication and other healthcare needs, according to a new report.
The Medicare Rights Center, a nonprofit customer service organization, analyzed more than 16,700 questions that it fielded through its helpline in 2016, and found confusion about enrollment, affordability and coverage concerns in Medicare Advantage as key challenges for Medicare beneficiaries.
Diving into this kind of data, according to the center, can guide policymakers looking to improve Medicare's programs.
"Year after year, our findings from the analysis of our national helpline data show that too many older adults and people with disabilities have problems navigating the complexities of the Medicare program and affording their coverage," Joe Baker, the group's president, said in an announcement. "It’s time that the real-life experiences of people with Medicare who are trying to access needed health care are taken into account and acted on to improve the Medicare program.”
Part B enrollment in particular is a point of concern, according to the report. Beneficiaries report consistently that they missed sign-up deadlines for Part B, as the process is hard to understand. People who may still be working but are transitioning to Medicare coverage are especially at risk for missing crucial enrollment points, and then facing higher costs or penalties.
Confusion about enrollment is an ongoing concern that the Medicare Rights Center has been tracking for years prior to its 2016 data, according to the report. The group said the bipartisan Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act, which was introduced in 2017, offers solutions it supports: More clear notification about when enrollment deadlines are approaching, and what eligibility requirements are.
Calls about coverage denials made up about 15% of those received to the helpline in 2016, and nearly half (40%) were related to Medicare Advantage, according to the report. Beneficiaries may have trouble following which physicians are in-network, which poses a significant access barrier.
MA beneficiaries have the option to appeal denied claims, but the process is too "onerous" for most of its members, according to the report. The Centers for Medicare & Medicaid Services can address these problems by improving its consumer education and outreach programs, and taking time to include information that would demystify the appeals process.
Affordability is an issue that impacts more Medicare beneficiaries than just those with low incomes, according to the report. About 1 in 5 calls to the center's helpline were related to costs, with 53% about Part B premiums and 43% about costs in Part D.
One solution is to offer exceptions on the specialty pricing tier included in many Part D plans, according to the report. This would allow beneficiaries to request price cuts for certain drugs in that tier—which includes some of the most expensive medications.