Less than a quarter of people with Medicare joining Part D drug plans in the first enrollment period called 800–MEDICARE or used the web-based drug plan finder developed by the Centers for Medicare & Medicaid Services (CMS) when selecting a plan, according to a new report released last week.

In its Report to the Congress: Increasing the Value of Medicare, the Medicare Payment Advisory Commission (MedPAC) analyzed enrollee decision making in choosing Part D plans. Based on a survey, interviews, and focus groups, MedPAC found that 19 percent of Part D enrollees or caregivers called 800–MEDICARE, the CMS help line, and only 11 percent used the plan finder web site as a resource. People were more likely to select a plan based on comparing information from individual plans than by using CMS resources. Most enrollees relied on the help of family and friends for deciding whether to sign up for Part D and for choosing a plan.

MedPAC also found that the main motivating factor for those who signed up for Part D was saving money on current drug costs. Individuals who did not enroll in Part D were less likely to need prescription drugs on a regular basis than those who did enroll. The report also notes that almost three–quarters of people who either had already signed up or were considering signing up gave "avoiding a penalty for enrolling later in the program" as a reason.

While cost and coverage of their drugs were considered the most important factors in selecting a plan, many enrollees found that the plans themselves were not very helpful in providing this information, according to the report. Many people with Medicare tried calling customer service lines, but had difficulty finding out whether their medications would be covered, researchers found. According to the report, about half of those who had signed up or were considering doing so described the decision as "difficult" and time consuming.

The report also highlights the burden experienced by counselors from State Health Insurance Assistance Programs (SHIPs) and other organizations in assisting individuals with the transition to Part D. Due to limited resources, counselors had difficulty responding to the record volume of calls during the enrollment period. One SHIP office saw an increase from an average of 3,000 calls a month to over 30,000 in November and December 2005. In February, another SHIP office's counselors were still returning phone calls from December.

Counselors report that many aspects of Part D were confusing for people who sought their help: the number of plan choices, variation in benefit structure, how to apply for the Extra Help program that assists low-income individuals, the "doughnut hole" (gap in coverage), and the late enrollment penalty.

(reproduced with permission from Medicare Watch, Issue 14)