Retirees have a good excuse for not understanding the complexities of Medicare. As it turns out, the people hired by the agency to explain its regulations and benefits often don't get it right themselves.
Nearly 4 in 10 calls to the 1-800-MEDICARE help line were answered incorrectly or incompletely, or got no answer at all, according to a recent audit by the Government Accountability Office. Twenty-nine percent of calls were answered inaccurately, and another 10 percent were disconnected or forwarded to an office that was closed. It is an appalling error rate for an agency that older Americans rely on when making health care decisions.
A call to the help line is answered by employees who have access to hundreds of computerized "scripts" that are supposed to cover every anticipated subject. But employees "did not always understand enough about the Medicare program to access a script that answered the question," the GAO found.
Even when they did get the right script, some misinterpreted the instructions. For example, eligibility for a motorized wheelchair is based on a recipient's "trunk strength" (meaning upper body strength), yet one help-line employee said Medicare would cover the cost only if the caller had "adequate space to put (the wheelchair) in the trunk of his car."
The underlying problem, the GAO found, was that those answering the phones were inadequately trained and tested. Before a new employee could begin taking real inquiries, he had to pass a test _ but that meant choosing the right script only two consecutive times in six attempts. You can't blame government workers for the poor performance because Medicare contracts the job out to Pearson Government Solutions, a unit of a London-based international media company. So much for the argument that privatizing government services is automatically more efficient.
While recent Medicare reform did spark a heavier call load, the GAO noted that Medicare could provide better service with three improvements that shouldn't have taken an audit to figure out: The agency shouldn't allow calls to be transferred to closed offices. It should make sure scripts are understood by employees and revise those that aren't. And it should monitor the accuracy rate of answers to frequently asked questions so that those with high error rates can be improved.
Although many recent calls concerned the drug discount cards offered earlier this year, that program is simple compared with the drug insurance plans that will be available in 2006. If Medicare's surrogates don't know that "trunk" has more than one meaning, what hope is there that they will be able to inform retirees about policy choices, copayments and coverage gaps?