Medicare News
| For Immediate Release: | Contact: |
| Thursday, June 17, 1999 | CMS Office of Public Affairs 202-690-6145 |
For questions about Medicare please call 1-800-MEDICARE or visit www.medicare.gov. |
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MEDICARE BENEFICIARIES TO GET STANDARDIZED BENEFIT INFORMATION
The Health Care Financing Administration today announced that Medicare beneficiaries will have standard information that will enable them to compare managed care organizations.
The new Summary of Benefits booklet will be a key addition to the materials available to Medicare beneficiaries. The standardized materials, which will be required beginning in the fall of 1999, will help beneficiaries compare the benefits offered and the costs charged for health care services.
"Beneficiaries rely on health plans for specific information about the costs and benefits offered by each plan," HCFA Administrator Nancy-Ann DeParle said. "These booklets are a first step to help them make apples-to-apples comparisons of Medicare managed care plans and will supplement the unbiased information available at 1-800-MEDICARE, on our beneficiary website, www.medicare.gov and included in the Medicare&You 2000 handbook.
"The Senate Aging Committee, led by Senators Grassley and Breaux, and based on findings by the GAO, recommended that we standardize plans' marketing materials, including descriptions of benefits, so that beneficiaries could more easily compare benefits between Medicare+Choice plans," DeParle said.
The new standardized booklet will contain three main sections:
- a beneficiary information section, providing information on the Medicare+Choice program in general terms (such as appeal rights and provider network requirements);
- a standardized benefit comparison section which informs beneficiaries about the benefits offered by the plan and compared to original, fee-for-service Medicare; and
- a special features section where plans will provide additional customized information, such as information about the provider network, maps to clinics and other benefits that may be available.
Medicare+Choice organizations have long produced "side-by-side" materials that compare managed care plan benefits with the benefits available from original fee-for-service Medicare. These have ranged from simple benefit comparison charts to graphics and more detailed descriptions. The wide variety of documents has caused confusion and difficulty among Medicare beneficiaries who may be thinking about enrolling in a managed care plan.
The standardized Summary of Benefits will be supplemented by additional information for beneficiaries, including enrollment forms and information about the Medicare appeals process. These materials are currently being consumer tested and will be ready for use in the fall of 2000. Managed care plans will maintain their flexibility in developing advertising material, provided they accurately reflect the benefits offered and meet all other regulatory requirements.
HCFA will also require plans to begin using a standardized format for submitting the detailed information about benefits, premiums, and cost-sharing. HCFA will use this information to review the accuracy of marketing materials and the financial soundness of each plan's benefit package. With more detailed benefit information in a format that uses standard terms HCFA will be able to provide a more accurate and consistent review of marketing materials.
"We are committed to making sure that beneficiaries have accurate, reliable information about their health plan choices," DeParle said. "The amount of information that will be available to Medicare beneficiaries, from both the Medicare+Choice plans and Medicare, will only help make them become even more informed health care consumers."
