GRASSLEY: HCFA MUST SECURE CLEAR INFORMATIONFOR MEDICARE BENEFICIARIES


Sen. Chuck Grassley, chairman of the Special Committee on Aging, today pledged to help ensure that older Americans receive critical information about their Medicare options.

"Congress has the responsibility of making sure Medicare works," Grassley said. "We have to fix what's wrong with the materials from Medicare managed care plans. Millions of people aren't getting the information they need to choose a health care option."

Grassley's comments came after an Aging Committee hearing, "Beneficiary Beware: Inadequate Review of Medicare Managed Care Plans Results in Incomplete Information for Consumers." The Committee released two General Accounting Office (GAO) reports documentingthe Health Care Financing Administration's (HCFA) inadequate review of Medicare managed care materials and a confusing appeals process.

Almost seven million Medicare beneficiaries are enrolled in Medicare managed care plans, Grassley said, compared with 32 million older Americans who remain in traditional Medicare. Congress created the option of Medicare managed care - known as Medicare+Choice - to give seniors more health care choices, he said.

Two Medicare beneficiaries testified before the Committee about their experiences with Medicare managed care. Lois Watts, a cancer patient from Laguna Hills, Calif., had difficulty with benefit coverage under two different Medicare managed care plans. William Stringer of Beavercreek, Ohio, was enrolled in a plan that under HCFA requirements, tried to enroll his wife while pulling out of their area.

The GAO found that Medicare+Choice will not reach its potential because seniors are not well-informed about their health care options, Grassley said. All 16 managed care plans studied by the GAO had provided seniors with "inaccurate or incomplete benefit information," despite HCFA's review of the benefit materials, according to one of the reports.

Grassley said specific examples of inaccurate benefit information identified by the GAO included:

  1. Materials from five managed care plans stating that beneficiaries must get a physician's referral to obtain an annual mammogram. Medicare prohibits the requirement of a referral for this service.
  2. One managed care plan marketed and provided a substantially less generous prescription drug benefit than the plan had contracted with Medicare to provide.

Grassley said HCFA's hearing witness announced a series of steps to beef up the agency's review of Medicare managed care plans. The steps include a follow-up review of plans' corrected documents and standard formats for benefit documents, he said.

Grassley said he will maintain aggressive oversight of HCFA's planned improvements.

"The intent of Medicare+Choice was to give older Americans more health care options," Grassley said. "We wanted to make their lives easier. Instead, inadequate plan information has caused headaches. If we want Medicare beneficiaries to have more choices, we have to give them the tools to choose."