Share of Cost, hat State or Federal laws, regulations, or policies or restrict competition and choice in healthcare markets

Sunday, Oct. 21st 2018 6:16 AM

What State or Federal laws, regulations, or policies (including Medicare, Medicaid, and other sources of payment) reduce or restrict competition and choice in healthcare markets?

Medicare can be confusing or even overwhelming, especially when a person has chronic illness, limited resources, or a lack of help. Choosing among traditional Medicare, Medicare Advantage (MA), Medicare Part D, and supplemental or “Medigap” options can make it almost paralyzingly complex. We rely on people with Medicare to make informed, savvy choices—in other words, to “vote with their feet”—so that competition can reward plan innovations that work, identify bad actors and problematic behaviors, and reduce both beneficiary and program costs. Yet, studies show that older adults struggle to compare plans1 and often do not change MA or Part D plans even when doing so may lead to lower premiums and reduced cost-sharing.2 To put it simply—people with Medicare are overwhelmed with information, but it may not be the information they need.

As policymakers consider putting beneficiaries on the hook for plan and health care choices, the absence of quality, useful information becomes increasingly punitive. We cannot support proposals that will shift costs to people with Medicare, penalize them for failing to make optimum choices, or otherwise transfer burdens onto their shoulders. Doing so becomes especially egregious when people are kept in the dark about what their choices are or what they might mean. The existing resources are insufficient. They must be improved before new complexities are added.

Currently the only Medicare choice tool is Plan Finder. While Plan Finder allows head- to-head comparisons of prescription drug plans, its utility is limited as it does not even allow a beneficiary to search across plans for particular providers. And there is no adequately-resourced tool to fill the gaps. The vital State Health Insurance Assistance (SHIP) program, which offers one-on-one personalized assistance,3 is woefully underfunded, faces challenges meeting current demands, and is constantly under threat.4 1-800- MEDICARE, while a needed resource, is no substitute for in-person assistance. We urge the administration not to move forward with any proposals to increase plan flexibility that would also further complicate beneficiary choice until adequate tools and resources are available for beneficiaries to effectively evaluate and compare their options.

We also note that as plan offerings become more complex, the administration’s responsibility to oversee plans appears to be getting less emphasis. Such oversight is an obligation that the Centers for Medicare & Medicaid Services (CMS) owes to beneficiaries, and is only increased by increasing complexity.

We might point out that CMS’s inability to negotiate prices for prescription drugs further compounds beneficiaries’ options, as plans are free to choose the pharmaceutical benefit managers that give them the “best price for a restricted formulary” regardless of how it will impact the beneficiary.

Recently an 81 year old beneficiary with diminished capabilities succumbed to marketing mailers from a United Healthcare plan endorsed by AARP and enrolled in a Medicare Advantage HMO plan without understanding the implications of her decision. She just “trusted AARP!” The local HICAP (California’s SHIP) will attempt to unravel her situation to ensure that she and her daughter understand the consequences of her decision, and make any needed changes based on her unique circumstances.



Posted on Sunday, Oct. 21st 2018 6:16 AM | by Share of Cost | in Social Security | Comments Off on Share of Cost, hat State or Federal laws, regulations, or policies or restrict competition and choice in healthcare markets