Report shows biggest areas of confusion over Medicare

Published Jan. 23, 2014

Medicare can be confusing in dozens of ways — take doughnut holes, Special Needs Plans, PDP coverage, late enrollment penalties and Medigap A through N.

Now, a study released Wednesday by the Medicare Rights Center zeroes in on the three most common issues that befuddle consumers.

The center, a nationwide advocacy group, fielded more than 14,000 calls on its consumer help line in 2012. Questions about covering out-of-pocket expenses — representing 21 percent of the calls — were no surprise.

Medicare's premiums, copayments and uncovered expenses consumed 26 percent of the average Social Security check in 2010, compared to 7 percent in the 1980.

Even more common were lesser known issues — calls about denials of benefits (33 percent) and enrollment into Medicare (23 percent).

Among other things, people with employer-based health insurance often misunderstand potential penalties if they turn down Medicare's Part B and Part D coverage at age 65 then sign up for it later.

It's a bit Byzantine.

People who are still working can usually remain on employer health insurance past 65 without penalty — as long as they sign up for Medicare promptly upon retirement. But already retired workers who are still on company policies will be penalized for refusing Medicare once they turn 65. If a worker receives both Medicare and company insurance, Medicare coverage is secondary at a big company with more than 50 employees, but primary at a small company.

The Medicare Rights Center has seen a distinct uptick in calls from people getting bad insurance advice from their employers, president Joe Baker said in a news conference.

"We are seeing a lot of disconnect between employer-provided information about when to enroll in Medicare and the facts,'' Baker said. "As employers cut back on HR (positions), the government needs to step up in other ways to make sure we have appropriate information to consumers.''

Medicare beneficiaries also continue to struggle with denial of benefits. A pharmacist won't fill a prescription that a doctor ordered because a Medicare drug plan has placed restrictions on usage. A private Medicare HMO tells a woman who broke her ankle that she needed prior authorization before heading to the emergency room.

Few people know how to appeal these decisions, Baker said, but those who do prevail about two-thirds of the time.

The report, "Medicare Trends and Recommendations," suggests that the federal government publicize appeal statistics for traditional Medicare, Medicare Advantage plans and prescription drug plans.

"That would be useful in picking plans,'' Baker said, "especially if there are lots of appeals in certain types of services.''

The Medicare Rights Center help line is at 1-800-333-4114. Florida's SHINE program also helps people with Medicare and Medicaid issues at 1-800-963-5337.

Editor's note: Charlotte Sutton, the Times' health and medicine editor, worked with the Medicare Rights Center on the report in her capacity as a graduate student in public health at the University of South Florida. She was not paid for the work.