Persistent Challenges for People with Medicare Identified in New Medicare Rights Center Report

Mitchell ClarkMedicare WatchLeave a Comment

Today, the Medicare Rights Center released its annual helpline trends report, which outlines persistent challenges facing people with Medicare heard through thousands of calls to its national consumer helpline.

The report, Medicare Trends and Recommendations: An Analysis of 2015 Call Data from the Medicare Rights Center’s National Helplinehighlights the leading issues heard on Medicare Rights’ helpline. Each issue is demonstrated through consumer stories and accompanied by policy solutions, which the Centers for Medicare & Medicaid Services (CMS), state agencies, insurers, elected officials, and others can pursue to improve the Medicare program for the more than 55 million people it serves.

Out of more than 16,000 questions posed by older adults, people with disabilities, and their caregivers in 2015, a variety of trends stood out among the questions from helpline callers, including:

  • Navigating Medicare Part B Enrollment: People eligible for Medicare who do not understand Part B enrollment rules or otherwise fail to enroll in Medicare when they first become eligible may face late enrollment penalties, gaps in coverage, and disruptions in access to needed care. Of 2015 enrollment-related helpline calls, the most complex issues without immediate resolution involved Part B enrollment and coordination of benefits.
  • Navigating Medicare Advantage: Medicare Rights fields thousands of calls from people across the country enrolled in Medicare Advantage plans with questions about how to switch plans, appeal a denied claim, or about plan cost-sharing. In 2015, as in previous years, questions about coverage and denial issues continue to be a major helpline trend. Within this subset, calls about Medicare Advantage plans’ denials of coverage present with the most frequency. The most recurrent type of call about Medicare Advantage plan denial of coverage was related to physician services.
  • Affording Medicare Coverage and Prescription Drugs: People with Medicare have very modest incomes and many have little to no savings. Most recent data shows that half of all people with Medicare live on annual incomes of $24,150 or less. Many helpline callers cannot bear their current medical costs associated with copayments, coinsurance, and deductibles.

At the same time, Medicare Rights continues to receive calls from people with Part D who are unable to afford the cost of their medications during all phases of their Part D coverage. Many callers are unclear as to why prescription drug prices remain costly and why they cost different amounts across plans. Many callers say that they cannot afford their medications but do not qualify for Extra Help, the federal program that lowers the cost of Part D medications.

Drawing directly from Medicare Rights’ more than 25 years of experience serving people with Medicare and their families, the report includes a comprehensive set of policy recommendations that address the issues heard on the helpline and to improve access to affordable health care for all people with Medicare.

Read the report.

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