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

November 19, 2018

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.