Medicare Prescription Plan: A Problem for Experts

The controversial and costly Medicare prescription plan took another blow this week when the GAO reported that call service representatives (CSRs) have an abysmal track record at answering questions. No wonder lay people find the decision process daunting.

Specifically, the GAO report shows that CSRs provided "accurate and complete responses to about one-third of the 864" completed telephone inquiries. Ten call centers were included in the study; each serves at least 100,000 citizens. (pdf)

Time reports that Medicare is "furious," claiming that the GAO asked "trick questions." However, government officials told GAO researchers in May that "CSRs should have been able to accurately answer the questions we posed."

The GAO says that the five questions were based on the FAQ on Medicare's website, discussion with beneficiary advocacy groups, and CMS (Centers for Medicare & Medicaid Services Centers) officials. Here they are - judge for yourself:

• My mother takes the following drugs: Norvasc, Fosamax, and warfarin sodium. Which of the sponsor’s plans would cost her the least amount annually and what is its annual cost?
• My mother-in-law takes the following drugs: Aciphex, Benicar, Evista, Levoxyl, Pravachol, Synthroid, Zetia, and Zoloft. Which of the sponsor’s plans would cost her the least amount annually and what is its annual cost?
• My mother automatically qualifies for extra help because Medicaid pays part of her Medicare premiums. Does the sponsor offer a plan that she can join without having to pay a premium?
• If some of my grandfather’s drugs are not covered, will he have to pay full price for them, or are there other things he can do?
• If some of my grandfather’s drugs are covered, but subject to restrictions, what does that mean?

Anyone who has tried to navigate these waters -- for self, parent, family member or friend -- will nod their heads at the GAO conclusion: "beneficiaries may have difficulty getting appropriate information from PDP sponsors’ call centers."

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