What you need to know about the forces reshaping our industry.


November 27, 2019

The Medicare Plan Finder tool got a big update. (It isn't going well.)

Daily Briefing

    CMS earlier this year updated the Medicare Plan Finder tool for the first time in a decade, but users are reporting various technical glitches with the revamped tool, which they say are causing inaccurate cost estimates.

    Slide decks: Health insurance 101

    Medicare's open enrollment period for the 2020 cover year launched Oct. 15 and is scheduled to close Dec. 7. A recent Kaiser Family Foundation analysis found beneficiaries on average have 28 Medicare Advantage (MA) plans and 28 Medicare Part D plans from which to choose for the 2020 coverage year.

    Background: CMS launches revamped Medicare Plan Finder

    CMS in August launched a redesigned Medicare Plan Finder, marking the tool's first update in a decade, the agency said. CMS said the redesigned Medicare Plan Finder would make it easier for beneficiaries to:

    • Compare the prices of traditional Medicare, MA, Part D, and Medicare Supplement Insurance (Medigap) plans;
    • Compare three drug plans or three MA plans side-by-side;
    • Determine whether a generic version of a certain prescription drug is covered under a plan;
    • Develop and modify personal prescription drug lists;
    • Find plan costs and benefits; and
    • Use their mobile devices, including their smartphones and tablets, to compare coverage options.

    But the Center for Medicare Advocacy, Justice in Aging, the Medicare Rights Center, and the National Council on Aging in a joint letter sent earlier this year to CMS raised concerns about the update's August timing. The groups wrote that third-party enrollment assisters, such as State Health Assistance Insurance Programs (SHIPs), might not have enough time to learn how the updated tool works before Medicare enrollment launched on Oct. 15.

    Insurance brokers, senior advocates, and volunteers also noted that the updated Medicare Plan Finder no longer allowed users to calculate a Part D plan's total cost based on a beneficiary's specific circumstances and medications. The updated version of Medicare Plan Finder allowed users to calculate the costs of copayments, deductibles, and premiums separately for different plans, but did not allow users to calculate those costs in total, as they could under the earlier version of Medicare Plan Finder.

    A CMS spokesperson said the agency recently added that feature back to the tool, so users again can sort health plans based on total costs.

    Users cite other issues with the tool

    But consumer advocates, Medicare advisers, and other users and observers in recent months have reported other issues with the tool, including malfunctions, missing or inaccurate information, and the tool's emphasis on plans with the lowest premiums rather than the lowest overall costs.

    Inaccurate, misleading info

    Brian McGarry, an assistant professor with the Division of Geriatrics and Aging at the University of Rochester's Department of Medicine, and his colleagues in the Health Affairs Blog wrote that the biggest issue is the tool's focus on premiums instead of total costs. McGarry and his colleagues noted that the tool automatically sorts health plans by premium. However, they explained that the plans with the lowest premiums likely are not the plans with the lowest overall costs, which makes the tool misleading.

    Christina Reeg, director of Ohio's SHIP, said if beneficiaries "pick the plan based solely on the premium, they are likely getting a plan that could cost them thousands more in a calendar year."

    Further, EnvisionRxPlus, a prescription drug plan, in an email sent last month to independent insurance brokers wrote that the tool did not provide accurate information for plans with deductibles that only apply to drugs on specific formulary tiers or for mail-order pharmacies, Inside Health Policy reports.

    In addition, Diane Omdahl, a Medicare consultant in Wisconsin, said the tool's comparison page at one point showed certain prescription drug plans would cover all of her client's prescription drugs except one. However, when she looked up additional details on the plans to determine which medication would not be covered, she found the plans actually covered all of her client's drugs. Omdahl then checked the health plans' websites and found there are two versions of her client's high blood pressure medication, but only one is covered. If her client had enrolled in a plan without coverage for the drug, the client could have been responsible for the drug's total price of $2,700 a month, ProPublica reports.

    Similarly, Ann Kayrish, senior program manager for Medicare at the National Council on Aging, said the tool sometimes shows users health plans that do not cover all of a potential enrollee's medications.

    Hannah Fox, a Senior LinkAge Line specialist who is helping Minnesota's Metropolitan Area Agency on Aging with Medicare enrollment, said specialists experience at least one error every day. "The plan finder is telling us that a medication is on a plan formulary—or not on the plan formulary—and, again, we're contacting the plan and getting the reverse," she said.

    Medicare advisers and consumer advocates have expressed concerns that the full effect of the tool's inaccurate estimates might remain unclear until the 2020 coverage year begins and beneficiaries start to use their coverage. Kayrish said, "Millions of people are going to be absolutely affected. And you hate to think about millions of people having the wrong plan. That's kind of crazy."

    Technical glitches

    Observers also have reported technical glitches with the tool.

    Omdahl said she recently experienced issues returning to the tool's main page after she applied limits to a MA plan's referral and prior-authorization requirements. She said it took her a total of 32 clicks to get back to the tool's main page.

    Alicia Jones, SHIP administrator in the Nebraska Department of Insurance and chair of the national SHIP Steering Committee, said she has identified about 100 errors with the tool since Oct. 1. For example, she said the tool has imported inaccurate medication amounts and has miscalculated costs.

    David Lipschutz, associate director of the Center for Medicare Advocacy, said, "It's not like there's one consistent problem that you can fix and then be addressed. It's really like a game of whack-a-mole."

    Lisa Bari—an independent consultant who previously worked on health IT, interoperability, and artificial intelligence at CMS did not work on the Medicare Plan Finder update—said the issues users are describing appear to be linked to calculation, coding, and logic errors as a result of poor user acceptance testing. Bari said user acceptance testing helps to ensure a software is able to complete real-world tasks, but it can be difficult to find enough individuals who have the necessary skills to appropriately conduct the tests.

    Still, McGarry and his colleagues acknowledged that the revamped tool also has some benefits. For example, McGarry and his colleagues wrote that the new tool allows users to compare MA plans and Part D plans, enter their Medicare identification numbers to automatically fill in the medications they have received under their Medicare coverage, and easily access the tool on mobile devices.

    Advocates call for extended open enrollment

    The Metropolitan Area Agency on Aging has asked CMS "to immediately remedy this situation and to extend [Medicare's] open enrollment period for at least three months once the Plan Finder tool is fixed." In addition, the group is advising individuals who already have signed up for a Medicare plan to verify the plan's pricing information and other details with the insurer.

    Sen. Bob Casey (D-Pa.), the ranking member on the Senate Aging Committee, said he will ask CMS to offer beneficiaries who have experienced issues with the tool a second opportunity to sign up for coverage through a special open enrollment period.

    CMS acknowledged that users have reported issues with Medicare Plan Finder, but said the agency has conducted "extensive consumer testing … to ensure that the information that is displayed is complete, streamlined, understandable, and is in plain language." CMS said the tool prominently displays premium costs because the user tests showed consumers are most familiar with premiums.

    As of Nov. 22, CMS had not published an alert warning users of the tool's potential inaccuracies, ProPublica reports  (Owens, "Vitals," Axios, 11/26; Johnson, ProPublica, 11/25; Alonso-Zaldivar, Associated Press, 11/21; Martin, Inside Health Policy, 11/15 [subscription required]; McGarry et al., Health Affairs Blog, 11/8).

    Have a Question?


    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.