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Medicare Call Centers Inadequate, Report Charges

October 12, 2006

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With the next enrollment period for the Medicare Part D prescription drug benefit looming, California Health Advocates and the Medicare Rights Center are demanding that the Centers for Medicare & Medicaid Services (CMS) require Medicare private drug plans to provide timely and accurate information to people with Medicare who turn to the plans' call centers for assistance.

According to a new report issued today by the two consumer organizations, call center representatives for companies offering Part D coverage remain unable to answer basic consumer questions regarding how the benefit works.

The report found that the call centers frequently could not provide the information people with Medicare needed to make appropriate enrollment decisions.

The two advocacy groups note in their report that plan call centers are expected to serve as a crucial link to information about Part D coverage, but "independent surveys and anecdotal reports from counselors show serious lapses in the ability of Part D plans to provide accurate and timely information and to successfully guide people with Medicare seeking to access the benefit."

"Good advice is the only antidote to the convoluted prescription drug benefit that older and disabled Americans are forced to navigate," said Robert M. Hayes, president of the Medicare Rights Center. "Too often a call to one of the private drug plans does more to mislead, than to help."

According to the report, CMS has failed to set adequate standards for the accuracy of information given by call centers.

In preparation for the next enrollment period, the report recommends that CMS provide detailed requirements for the information customer service representatives (CSRs) must be able to provide, and take action to ensure those requirements are being met.

The report recommends that CMS ensure that the training and scripts provided to call center operators enables them to provide information about the following:

• Enrollment process

• How the specific plan works, including explanations of the coverage gap and important information for people eligible for the low-income subsidy

• Plan formulary, including which drugs are covered and specifics on any coverage restrictions and limitations.

The report also recommends strengthening Medicare private drug plans' capacity to communicate with non- and limited-English speakers and designating staff as experts in specific subject matter, such as enrollment, premium/cost-sharing, and coverage appeals.

The full report, including detailed recommendations, can be found at: www.cahealthadvocates.org/advocacy/2006/10.html.

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