Top concerns for Medicare beneficiaries: Part B, appeals and affordable medications

Calculator that says "Medicare" on it on top of money, next to bottle of pills
Medicare beneficiaries' biggest concerns include navigating Part B. (Getty Images/liveslow)

The top concerns of Medicare enrollees include navigating Part B, appealing Medicare Advantage (MA) denials and affording meds, according to an annual report from the Medicare Rights Center.

“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, president of the Medicare Rights Center, said in a statement. “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.” 

The top three patient concerns in 2017 were determined by questions and answers addressed via the Medicare Rights helpline or searched for on Medicare Interactive website. 

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In the first investigation, Medicare Rights dove into the navigation of Part B. The report states that it is not uncommon for people to make mistakes when enrolling in Part B, and these mistakes often include late enrollment penalties, higher out-of-pocket costs and gaps in coverage.

Through the helpline, the Medicare Rights Center received about 26% of all questions focused on Part B enrollment, ranging from how to enroll, when to enroll, and whether or not to enroll at all. 

RELATED: MedPAC: Tweaks to Part D erode incentives to keep costs down

“Contributing to the problem is the lack of a universal written notice about the need for people to actively enroll in Part B, or the availability of information about the Part B Special Enrollment Period (SEP), a right available to certain individuals under specific circumstances,” the report stated. 

To remedy this situation, the group advocates for the passing of the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act, which would require universal written notice about the enrollment requirements for Part B and help to streamline the actual enrollment process. The organization also believes the government should allow for more people to have access to Medicare Special Enrollment Period (SEP). 

The second most common issue talked about in the report is helping clients to appeal MA denials, the subject of every one-in-three calls on the Helpline. The Office of the Inspector General reports that only 1% of MA enrollees ever appeal denied claims, but for those who do, 75% of the decisions are reversed. But the fact remains that many denied claims are confusing to enrollees and so are not further pursued, the group found.

Plus, some enrollees do not know that providers who were in-network under Original Medicare may not be in-network with MA. 

Related: Advocacy groups blast CMS for incorrectly promoting MA plans

“To help people with Medicare make optimal health care choices in this increasingly complicated environment, the federal government must provide beneficiaries with comprehensive, easy-to-understand, and unbiased tools and resources,” the report said. 

And Medicare Rights is putting pressure on how Centers for Medicare & Medicaid Services (CMS) oversees the MA program, looking for it to streamlining the process and holding them accountable if plans do not comply with rules and requirements. 

Finally, the report addresses the top Medicare concern of affordable prescription drugs. In 2016, Medicare households spent 41% more on healthcare than non-Medicare households, and 20% of beneficiaries’ spending was on prescription drugs. 

The group explains that access and affordability are the top priorities for prescription drugs moving forward. The organization asks for increasing access to low-income assistance programs and imposing a cap on out-of-pocket beneficiary spending. Plus, Medical Rights supports overall lower drug prices by letting Medicare negotiate Part D costs, increasing transparency, and realigning incentives for low-cost, high-efficiency treatments. 

Moving forward, Medicare Rights expects that 2018 data will show similar trends, and "our job will be to tell the story of these trends in a new way, and to present policy recommendations that take into account current realities," Rachel Bennett, vice president of program and product development at Medicare Rights, told FierceHealthcare. "Medicare Rights listens to the policy concerns that clients raise, with questions so far this year having to do with differences between Original Medicare and Medicare Advantage, the impact of potential Medicare cuts on beneficiaries and their families, and how various drug pricing proposals may affect people with Medicare."

Julie Carter, senior federal policy associate at Medicare Rights, says the organization is asking the current administration to prioritize Medicare beneficiaries’ access to affordable, high-quality care and prescription drugs.

"This includes working with Congress to extend Medigap protections to more beneficiaries, ease access to Medicare’s low-income assistance programs, and streamline the Medicare appeals processes," she said. 

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