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What Medicare Beneficiaries Don't Know May Hurt Them

Les Masterson, for HealthLeaders Media, September 17, 2008

Health insurers are regularly pummeled for customer service lapses, and they often deserve the criticism. But they are not the only ones who merit a rap on the knuckles. The Medicare program is not doing a good job engaging its beneficiaries either. In fact, a Senate Special Committee on Aging hearing last week showed Medicare's helpline has not been helpful. Committee member Sen. Gordon Smith (R-OR) spoke of disappointing results from a three-and-a-half-year investigation that was sparked after concerns about the influx of calls related to Medicare Part D and Medicare Advantage.

In 500 test calls, the senator's staff alleged wait times ranged from zero to 45 minutes, and six calls were disconnected while on hold. Another shocking statistic is that the call centers, staffed by a company called Vangent, were wrong or unable to answer at least one question 90% of the time, he said.

Vangent disagreed with that statement and alleged that surveys show 85% of callers are satisfied with the call centers' work.

One person who definitely is not is Naomi Sullivan, a dual-eligible 57-year-old woman from Chico, CA, who testified about her call center experiences. After being mistakenly enrolled in Medicare Part D rather than Medicare Advantage, Sullivan called 1-800-Medicare and told a representative that she could not afford the plan premiums on her less than $700 per month disability check. She wound up in collections because she couldn't pay for her health insurance, other bills, and food.

What was one call center representative's response to Sullivan? Get a part-time job. Sullivan wasn't told she was eligible to switch plans, which would have resolved some of her payment issues.

"I just needed a little help and some direction in how to get things sorted out. I didn't get that help from Medicare," Sullivan told the committee last week. Medicare reportedly isn't doing a good job with 1-800-Medicare, but what about its Web site, which is supposed to help beneficiaries?

Last month, a University of Miami study reported that beneficiaries found the Medicare Web site difficult to navigate and they were unable to gain the information they wanted. They also told researchers that some of the language was too complex.

These two communication problems will hopefully prod Congress to action. The feds are fond of investigations, and Medicare's communication problems are an area to explore. Communication problems will only become a larger problem over the next 10 years. Medicare's call centers are expecting 34.5 million calls in 2009 and the Web site will see more eyeballs as the Internet continues as a popular source of healthcare information. CMS must get its act together fast. The baby boomers are coming-and you won't like them when they're angry.


Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com
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