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Evaluating Medicare’s New Tools for Open Enrollment

For the 2019 Medicare Open Enrollment period, the Centers for Medicare and Medicaid Services (CMS) released three new web tools, available on Medicare.gov, which are designed to help Medicare beneficiaries better understand and compare their Medicare coverage options.

At the same time, CMS released minor updates to the Medicare Plan Finder. We reviewed the three new tools, in part applying the expertise and knowledge we gained from working with beneficiaries for our Modernizing Medicare Plan Finder Report. Two of the tools were responsive to recommendations included in our report.

We found that in general, the new web tools are consumer-friendly and serve as a good starting point for making choices. However, beneficiaries should not rely on them alone for picking a plan. Instead, they should use them as a starting point before using the more detailed and accurate full Medicare Plan Finder or before contacting a local State Health Insurance Assistance Program (SHIP).

Coverage Options Quiz

Overview: For most people, a first step to finding the best type of Medicare coverage could be to take the Coverage Options Quiz (or Wizard) to compare Medicare Advantage (MA) and Original Medicare Fee-for-Service (plus a standalone Part D and Medigap plan). This five-question quiz considers a person’s interest in prescription drug, vision, and/or dental coverage; coverage for Part B 20% coinsurance; and if a person travels frequently.

Needed Improvements: While short and easy to use, the quiz does not gather essential information needed to determine which option is better for an individual. For example, it does not consider whether a beneficiary’s doctors are included in a plan’s network, and it does not recognize different Medigap plans or provide information on the plan’s guaranteed issue limitations. These factors are central to the Original Medicare verses Medicare Advantage decision – yet, they are not mentioned in the quiz or on the results page.

Out-of-Pocket Cost Calculator

Overview: The Out-of-Pocket Cost Calculator estimates out-of-pocket costs for Medicare Advantage or Original Medicare (with or without supplemental coverage). It accounts for four factors: where you live; self-reported health status; if you want prescription drug or Medigap supplemental coverage; and if you want a low, medium, or high premium. Again, this tool is easy to use, and is a good starting point for understanding costs.

Needed improvements: To be truly accurate and reliable, the calculator should be more personalized. It does not incorporate a person’s specific drugs, which are a significant contributor to out-of-pocket costs. It could also include questions that reflect what health services a person may use, such as how many times they expect to go to their primary care physician. The tool also is too focused on premiums. It doesn’t reflect the tradeoffs between premiums and cost sharing or the different Medigap coverage that is available.

Web Chat

Overview: When logging into MyMedicare.gov, beneficiaries can now ask for help with plan selection via a web chat. The program is a pilot test staffed by 1-800-MEDICARE representatives.

Needed Improvements: More information is needed to determine whether the web chat will be a helpful tool for beneficiaries. We hope that CMS will be transparent about the results of the pilot, so we can work with the agency to make it useful.

Supplemental Benefits

Beginning in 2019, MA plans can offer an expanded list of supplemental benefits, beyond dental, vision, and hearing. We had hoped that the Medicare Plan Finder would be updated to allow beneficiaries to easily access and compare information about these new benefits. Many of the new benefits include social services, such as transportation, meals, home modifications, or respite care. According to Avalere, over 40% of plans are offering these types of new benefits.

Yet, the only reference to them is under the Benefits Highlight section of Plan Finder, which asks whether a plan has “additional benefits and/or reduced cost sharing for enrollees with certain health conditions.” If the answer is yes, beneficiaries are instructed to leave the Plan Finder website and contact the plan for more information. We are concerned this will be time-consuming and confusing for many beneficiaries trying to navigate the complex web tools.

The new calculator and web chat are recommendations included in our Modernizing Medicare Plan Finder Report. However, both could use needed improvements and the web chat is still an unknown.

NCOA would like to work with CMS to improve the usefulness of these tools for consumers, and we encourage CMS to work with SHIPs, beneficiary groups, and other stakeholders for their input going forward.

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Howard Bedlin

About Howard Bedlin

Howard Bedlin is NCOA's Vice President of Public Policy and Advocacy. He is responsible for all of NCOA’s federal and state legislative advocacy efforts on issues and programs of concern to older adults, which include the Older Americans Act, Medicare, Medicaid, long-term care, income security, and community services programs.