5 Challenges, 5 Policy Solutions for the Medicare Enrollment Process

October 08, 2020 - Beneficiaries suffer from chronic confusion over Medicare enrollment but policymakers can take action to streamline the process and improve beneficiary experience, Better Medicare Alliance asserted in a recent white paper.

“The limitations of our current Medicare enrollment process do a disservice to our nation’s seniors, too often leaving new entrants uncertain and unable to make decisions that would benefit their health and well-being,” Allyson Y. Schwartz, president and chief executive officer of the Better Medicare Alliance, said in the press release.

“Even as changes have been made to improve the information available to beneficiaries, confusion and difficulty remain. With over 10,000 people turning 65 years every day in our country, we can do better.”

A 2019 study commissioned by Better Medicare Alliance found that nearly half of all Original Medicare beneficiaries were unaware that Medicare Advantage plans existed.

Meanwhile, well over a third of Medicare beneficiaries (37 percent) are confused by Medicare enrollment support resources, a separate survey by GoHealth found. Ahead of the 2021 Medicare open enrollment season, respondents indicated that health literacy and cost would present major barriers for enrollees.

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Better Medicare Alliance outlined five evergreen challenges that beneficiaries face and five ways that HHS, CMS, and policymakers on Capitol Hill can improve the Medicare enrollment process.

Challenges of Medicare enrollment

Better Medicare Alliance identified five challenges for Medicare beneficiaries around enrollment.

First, there is no single government entity in charge of enrollment. Instead, beneficiaries receive communications from numerous unassociated entities. Furthermore, the enrollment process takes place via the Social Security Administration instead of CMS, which experts said seems like a more natural option.

Second, beneficiaries can accrue penalties for not making a decision within the timeline or for choosing the wrong health plan.

Third, beneficiaries have a strict window of seven months around their 65th birthday to select their plan, which can lead to a rushed decision.

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Fourth, comparing health plans remains challenging. Although CMS tried to fix its Medicare Plan Finder website to make it more navigable, some have criticized the updated site as presenting similar problems as the previous version’s.

Fifth, beneficiaries continue to suffer from a lack of personalized education on their health plan options. Navigators are available but cannot recommend specific plans and sufficiency of navigator training varies by state. The Medicare & You booklet that CMS issues each year to cover Medicare plan options is not tailored; the handbook for 2021 spans 124 pages.

Five policy recommendations to improve Medicare enrollment

To address these enrollment concerns, Better Medicare Alliance offered five policy recommendations ahead of open enrollment for plan year 2021.

HHS should take over Medicare enrollment, the organization recommended, with the enrollment process designated specifically to CMS. Thus, education materials and enrollment processes would be within the same agency and department.

Better Medicare Alliance also stressed having Medicare subject matter experts available locally. CMS should employ the Administration for Community Living to oversee the State Health Insurance Assistance Program (SHIP).

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The second policy recommendation addressed updating the educational resources for potential enrollees. Organizations and businesses that offer Medicare guidance but are unaffiliated with CMS should be subject to a review to ensure that their information is correct.

"Enforcement actions should be increased for those that misrepresent Medicare’s brand and information,” the white paper added.

Additionally, the Medicare & You handbook needs to be updated with input from a diverse set of Medicare beneficiaries as well as beneficiary advocacy groups regarding what information and format would be most useful for enrollees.

In its fourth policy recommendation, Better Medicare Alliance pushed for the beneficiary engagement process for Medicare enrollment to begin earlier, at the age of 64. This would require a Congressional move to officially extend the timeline, giving beneficiaries more than seven months to consider their options.

Finally, CMS needs to continue to hone its Medicare Plan Finder tool. The next update should include filters that allow beneficiaries to search by out-of-pocket costs, provider network, supplemental benefits, chronic disease management or other condition-specific programs, and Star Ratings.

“The tool should enable individuals transitioning from Medicaid or private coverage to more easily find coverage options based on their preferences regarding continuity of care and care delivery model, such as integrated care,” the white paper added. “The tool should also be available to caregivers, family members, or others authorized to assist the beneficiary in exploring options. Searches should be able to be saved and returned to by the beneficiary or designee.”

As with the Medicare & You handbook update, beneficiaries should be integrally involved in the process of revising this tool.

“Systemic solutions and reforms such as those recommended in this report are critical to ensure that all Medicare beneficiaries have timely, trusted, complete and clear information about their enrollment options and confidence that they can make the coverage choice that will best meet their health and financial needs,” the white paper emphasized.