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Medicare Heads Up: December 6, 2019

A round-up of the state and national Medicare news that matters to consumers

A revamped Medicare Plan Finder tool has been widely criticized as being difficult to use and providing inaccurate cost estimates and incorrect information. CMS has denied technical issues and says the tool is consumer friendly.

Welcome to Medicare Heads Up, a regular feature intended to deliver state and national Medicare-related headlines that will keep consumers abreast of developments that affect their coverage and costs. This week:

Open enrollment is ending this week, but you still have options

Medicare open enrollment for 2020 ends on December 7, but that isn’t your last chance to get coverage for 2020. Here are upcoming opportunities to enroll or change coverage –  and deadlines to mark on your calendar:

Most beneficiaries don’t switch Medicare drug plans during open enrollment

The number of Medicare enrollees swapping Prescription Drug Plans (PDPs) during Medicare open enrollment decreased from 2014 to 2016 – in both Part D (between 10% and 13% switched) and Medicare Advantage plans (between 8% and 11%). The lack of movement could prove to be a landmine for consumers due to the frequency with which PDP coverage and pricing change from one year to the next. Although no single culprit is to blame, it seems that PDPs suffer from the same combination of consumer confusion, apathy, and cost factors that keep those in other types of health plans simply renewing – rather than researching options.

Medicare Advantage partnerships with senior living facilities could be cost-cutting future of care

Motivated by a desire to take advantage of expanded Medicare Advantage supplemental benefits, some insurers are partnering with senior housing facilities and providers to create a “one-stop-shop” Medicare Advantage special needs plan (SNP). The hybrid partnerships seek to provide care coordination and services that are specific to the needs of seniors who are living in long-term care facilities. Beneficiaries who reside in a participating facility would be assigned a care coordinator, and receive on-site provider visits as a covered benefit. One such partnership plan, available for 2020, waives the three-day hospital stay requirement for coverage of skilled nursing facility care, and also provides dental, vision, hearing, and transportation services.

Consumers will see more Part D options and a wide range of costs in 2020

Consumers in search of a Medicare Prescription Drug Plan (PDP) will find more options than in 2019, but they will also see a wide range in premiums and higher costs. For 2020, more than 948 PDPs will be available nationally – 200 more plans than in 2017 – with an average of 28 different plans available to each beneficiary. Stand-alone PDPs premiums range in price from $13/month to $192/month, with an average premium increase of 7 percent ($42.05 a month). For the 86 percent of PDPs with a deductible, the maximum deductible will increase to $435, from $415 in 2019.

California tops states in Medicare Advantage enrollment

Medicare Advantage enrollment has climbed to 22 million beneficiaries in 2019 – or 35 percent of all potential Medicare eligible customers – and the rapid growth of Advantage plans has no end in sight. With the continued market penetration and a friendly regulatory climate, the growth of the plans could reach 70% of the entire Medicare marketplace by 2030 – 2040.

The top five states for Medicare Advantage enrollment:

  • California (2,785,725)
  • Florida (2,122,993)
  • Texas (1,687,732)
  • New York (1,538,736)
  • Pennsylvania (1,174,686)

Revamped Medicare Plan Finder wildly criticized; CMS says it’s consumer friendly

In an attempt to improve the consumer experience, CMS overhauled the Medicare Plan Finder tool, with the new version debuting just in time for the open enrollment period in the fall of 2019. Since the revamped Plan Finder launched, brokers, healthcare navigators, consumer advocates, and even the Delaware Department of Insurance have criticized the website as being difficult to use, not providing accurate cost estimates, and even of presenting incorrect information. CMS has denied technical issues with the new Plan Finder, but assures it is “doubling down” on staff to assist beneficiaries who may have enrolled in the wrong plan due to inaccurate or misleading information. CMS reports user traffic has increased 14 percent over last year.

Jesse Migneault is a journalist and editor who has written about business, government and healthcare – including public and private-payer health insurance. His articles have appeared in HealthPayerIntelligence, the Hartford Courant, Portsmouth Herald,, Foster’s Daily Democrat, and York County Coast Star.

In addition, his work has been cited by health industry stakeholders such as the Eugene S. Farley Health Policy Center, Association of Healthcare Journalists, American Academy of Actuaries, Kaiser Permanente, blueEHR, San Diego Law Review, Medicare Agent News,, and Concierge Medicine among others.

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