The Centers for Medicare and Medicaid Services' new Plan Finder platform is misleading seniors
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The Centers for Medicare and Medicaid Services' (CMS') updated Medicare Plan Finder tool has reportedly been malfunctioning throughout this year's Medicare open enrollment period, offering some users incorrect price estimates and coverage information, according to ProPublica.
The CMS unveiled a redesigned version of the tool in August with the goal of improving usability and allowing beneficiaries to easily compare Medicare Advantage (MA) and Part D plans based on their coverage needs. And while the update was needed to address longstanding complaints, critical software malfunctions in the redesign could have disastrous unintended effects for some Medicare beneficiaries.
Selecting the wrong coverage could lead to increased healthcare costs for seniors — who would have no option for recourse until next year's open enrollment period. One Nebraska insurance administrator says she's flagged approximately 100 errors since she began working with the tool October 1st, and a Medicare consultant in Wisconsin uncovered false information around the coverage of high blood pressure medication that equated to a $2,700 difference in monthly costs for her client, per ProPublica.
This alarming news comes at a time when many in the US are already struggling to keep up with the high cost of prescription medicine: Nearly 30% of US consumers say that they've avoided taking their medication as directed in attempts to cut down drug spending. And if seniors end up enrolling in a health plan that doesn't cover the medications and services they need, they're likely to be hit hard with unexpected bills when they pick up their first prescriptions come January.
In response to the revamped Plan Finder tool's misguidance, health insurance organizations and prescription drug plans are taking action:
Groups nationwide have issued statements urging Medicare members to double check their benefits, some have temporarily shut down operations, and others have advised staff against using the digital platform entirely. "Specialists know what to be looking for, so they can ID something that might be wrong. But an ordinary person who is just looking by themselves really won't be alerted to an issue," Julie Roles, spokesperson for Minnesota's Metropolitan Area Agency on Aging, told ProPublica.
And while the CMS has acknowledged some issues with its platform, the agency also said the development of its $11 million redesign was an iterative process, per ProPublica. The Metropolitan Area Agency on Aging has called on the CMS to immediately rectify the situation and to extend open enrollment by at least three months after the Plan Finder tool has been fixed. But at the time of writing, there isn't so much as an alert on Medicare.gov to warn users of potential problems with the new Plan Finder tool.
And MA insurers will likely be the ones to face consumer backlash over coverage gaps, despite the blame lying squarely on the CMS' shoulders. When we first covered the CMS' Plan Finder redesign, we highlighted the potential boost it could provide for MA plans, particularly those from young insurtechs, like Clover and Devoted Health.
Collecting information about a variety of MA offerings could help smaller insurance companies elevate their profile and steal away some market share from the large, legacy players currently dominating the market. But if seniors start filling their prescriptions next year and are met with exorbitant prices for the drugs they need, it could lead to a backlash against those nascent insurance players, as consumers would likely blame their plan provider and not the CMS itself.
Ultimately, it's in everyone's best interest to quickly resolve the issues plaguing the new Plan Finder, make certain that patients are alerted and made aware of any potential inaccuracies they may come across or have already been exposed to, and ensure that there are mechanisms in place to address mistakes in coverage selection stemming from the CMS' flashy — yet flawed — new software.
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