What If Experienced Drug Plan Reviewers Had Designed The Medicare Plan Finder?

In August 2019, the Centers for Medicare and Medicaid Services (CMS) completely revamped the Plan Finder. A promotional video said the new design would make it easier to learn about and compare coverage options and select the best plan. In a press release, the CMS Administrator at that time said, “Try it out and let us know what you think.” I tried it out, found many issues and wrote almost a dozen Forbes posts since then. 

Now, we are in the midst of the 2021 Open Enrollment Period (OEP), the third one using the revised Medicare Plan Finder. I talked with four experienced drug plan reviewers. It is their unanimous opinion that the Plan Finder still has problems that interfere with finding the best plan. And they question the drug plan review experience of the developers. 

Here’s a list of issues you wouldn’t find if these experienced reviewers had been involved in the update of the Medicare Plan Finder. 

Wrong information about drug payment stages

This is one big indication that the Plan Finder team does not understand drug coverage and reviews. Medicare drug plans have four payment stages. When and how quickly you move through the four stages can have an impact on your annual costs. The Plan Finder tries to describe when those moves happen but there are mistakes that result in misleading information. 

Plans with no drug deductible

The standard drug plan deductible in 2022 will be $480. Plans can opt not to charge a deductible and then Initial Coverage costs would apply at the start of the year. 

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For plans with no deductible, the Plan Finder says, “You won’t meet your deductible in 2022.” That is confusing and should say something like, “The deductible does not apply.”

The problems don’t stop there but the payment stages in the Plan Finder do. The other three payment stages do not seem to matter for plans with no deductibles. Consider this example. A beneficiary takes 12 medications, including three Tier 3 and four Tier 4. The total drug costs will take the beneficiary all the way to Catastrophic Coverage. However, if the plan has no deductible, the Plan Finder notes he won’t meet the deductible in 2022 and stops there. There is no indication of when he will reach the Coverage Gap or Catastrophic Coverage. This is essential information for comparing costs but it’s missing in the Plan Finder.

Out-of-network pharmacies

If a preferred pharmacy is not in the plan’s network, the drug payment stages do not apply. That’s because a beneficiary must pay 100% of the costs. But, based on the full cost of the drugs, the Plan Finder notes these individuals will land in the Coverage Gap or Catastrophic Coverage in the first few months. 

Noncovered medications

Just as with out-of-network pharmacies, a beneficiary must pay the full cost of a noncovered drug, one that is not in the plan’s formulary. The Plan Finder says you won’t meet the deductible. But again, the deductible does not apply since the beneficiary must pay the full price. 

The Plan Finder also buries information (that previously appeared automatically) about noncovered drugs behind a link labeled, “View more drug coverage.” An experienced reviewer would never bury that essential information. 

Meeting the deductible 

Many plans have a deductible and many beneficiaries meet that deductible but, because their costs don’t reach the threshold, they never reach the Coverage Gap. The Plan Finder notes they won’t enter the gap, which is correct, but then adds they “won’t get out of the Coverage Gap.” If they don’t enter, of course, they won’t get out, another nonsensical statement.  

$35 insulin

In 2020, CMS launched the Part D Senior Savings Model. Participating drug plans would offer selected insulins for no more than $35. The 2020 Plan Finder helped beneficiaries find those plans by adding a filter for insulin savings. 

This year, that filter has disappeared. Who knows why but it would certainly help diabetic beneficiaries find the best plan.

Default drug doses 

In May of this year, I noticed a problem with default drug quantities that show up automatically after selecting the drug and dose. The description of the packaging set the default. An example: a plastic container of 60 eye emulsions defaulted to a monthly quantity of 60. Within a few weeks after I wrote about this, those significant issues were fixed; however, with the recent redesign the problem has returned. Here are some examples (with the default quantity for a one-month supply): 

  • Atenolol 50 mg, default quantity 90: That’s three times the recommended dose. 
  • Statin medications, default quantity 45: That’s 1½ tablets a day, more than the recommended dose. 
  • Two “off the wall” examples are Gabapentin 400 mg., default quantity 270 and metformin 500 mg., default quantify 360. The recommended quantity is 60 for each drug.

Experienced drug plan reviewers will likely catch these errors right away, but what about everyone else?

Not being able to save drug information without a mymedicare.gov account

If there is one dead giveaway that inexperienced drug plan reviewers designed the Plan Finder, this is it. To save drugs, you need to establish an account, which takes a Medicare number. Those turning 65 or retiring at age 70 don’t have Medicare numbers. For whatever reason, many beneficiaries can’t or won’t establish an account. Just the other day, I was doing a review for an 84-year-old who took 17 medications. I accidentally closed the browser just as the plans appeared and I had to start over. This was not only frustrating but a waste of time. 

The auto-correct function for drug entry

Then, a little comic relief perhaps, this one is simply laughable. Start typing Olmesartan and Holmes pops up in the drug spot. Or, try rosuvastatin and rouse appears, listing muse as the drug. Perhaps the designers thought auto-correct would be helpful, but it is an annoyance. 

CMS said this version of the Plan Finder was supposed to make it easier to find the best drug plan. However, because there are so many issues with the tool that reflect a lack knowledge about the process, experienced reviewers have to pay attention at every level. One can only imagine how difficult this is for beneficiaries.

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