Accountability

Asclepios Your Weekly Medicare Consumer Advocacy Update from the Medicare Rights Center November 6, 2008 • Volume 8, Issue 45 The Government Accountability Office has provided the incoming Obama administration with a “to do” list for Medicare. Many of the items on the list are designed to ensure taxpayers and people with Medicare receive fair value for the payments we make to private Medicare health and drug plans. Here are a few of the highlights:

• “Determine the magnitude of Medicare payments made to prescription drug plans under its retroactive coverage policy.” When an enrollee in a drug plan qualifies for Extra Help, there is usually a period of retroactive coverage lasting at least one month, and often three or four months. Drug plans are obligated to refund these low-income enrollees for excess premiums and copayments they made during this period. Although drug plans receive additional taxpayer subsidies covering these months, the Medicare Rights Center has found it usually takes a fight to get plans to pay these refunds. It should happen automatically. The Medicare Rights Center believes payments to plans should be withheld until they can demonstrate the proper refunds have been made.
• “Improve the Medicare Part D coverage determination and appeals process.” The Centers for Medicare & Medicaid Services (CMS) needs to step up monitoring and enforcement, particularly of drug and health plans that regularly delay or obstruct appeals or that have their decisions overruled upon independent review. Plans that fail to abide by appeals timelines or ignore evidence from doctors supporting coverage are putting the lives of people with Medicare at risk.
• “Work with key partners to plan, prioritize, and execute end-to-end testing to mitigate the risks associated with implementing Part D information systems changes.” When systems problems put consumers in limbo—for example, by preventing enrollment in a private drug or health plan, or in Original Medicare—it can take months to resolve. During that time, people with Medicare may be unable to see their doctor or afford to fill their prescriptions. Similarly, low-income individuals can lose access to medicines when their Extra Help status does not show up on their drug plan’s computers.

The GAO points to other means for improving accountability by private plans. One report highlights that enrollees in some Medicare private health plans pay higher cost sharing for medical services than they would under Original Medicare, even though these plans receive subsidies that cost taxpayers more. That is certainly something the new Obama administration can fix as it sets the contract terms for plan offerings in 2010.

Medicare requires other improvements as well. People with Medicare urgently need a consumer education system that combines 21st-century technology with the one-on-one help best provided by state health insurance assistance programs and community-based organizations.

The GAO highlights some key priorities but there is more to be done. The best guide is this principle:

All Medicare’s contractors—from insurance companies to wheelchair suppliers—must be accountable to taxpayers and responsive to the needs of people with Medicare.