Medicare Compliance & Reimbursement

Agency acknowledges problems with site.

Medicare's new Internet-based tool for beneficiaries, the "Prescription Drug Plan Finder," is already garnering some negative reviews from public advocates and members of Congress.

Most arguments from both sides claim that the plan finder fails to inform beneficiaries adequately about whether their drug plan will cover their prescription medications and how much the premiums and co-pays will be if the plans do cover them.

"As it stands, the Web site does not provide adequate information for beneficiaries to make informed decisions about what plan would be best for their needs or what level of out-of-pocket spending they might incur under any given plan," said Sen. Tom Carper (D-DE) in a letter to Centers for Medicare and Medicaid Services administrator Mark McClellan.

A senior-citizens advocacy group, the Medicare Rights Center, has issued a warning to benes, their caregivers and health care professionals to avoid using the plan finder altogether.

"The tool is misleading at worst, useless at best, until it includes accurate information about what medications are covered by the drug plans," MRC president Robert M. Hayes said in a statement.

CMS unveiled the drug plan finder on its Medicare Web site as just one of the new resources the agency has launched recently. The goal with these new tools is to train local partners, such as the State Health Insurance Assistance Programs and senior centers, to teach benes about drug-plan enrollment, which begins Nov. 15.

The tool should allow benes to compare insurance plans based on factors such as cost, coverage and convenience, CMS said. The finder should also provide members personalized information on particular plans and help them determine if they qualify for more payment assistance and to check up on their employer's coverage status.

CMS did acknowledge that the finder had incomplete data during its initial weeks, because the deadline for many employers to submit their applications was Oct. 31. Also, some applications for those beneficiaries who applied for extra help had not been finalized, CMS said.

But critics of the tool are citing more problems than simply incomplete data. For example, in his letter to CMS, Carper pointed out that the finder does not:

• allow users to enter the medications they currently take to find out which plans cover those medications;

• include clear information about how much seniors would have to pay for their medications; or

• provide clear information about other "out-of-pocket" costs.