The Office of Inspector General (OIG) issued two reports in February 2000 concerning Medicare+Choice marketing materials and a third report that examined why beneficiaries enroll in a Medicare+Choice HMO. Once again, the OIG found that marketing materials are incomplete and/or misleading.
According to the reports, HCFA's National Marketing Guide has not meet its goal of providing Medicare beneficiaries with accurate and "consumer friendly" marketing materials. Eighty-seven percent of the HCFA-approved marketing materials reviewed by the OIG either contained statements that were specifically prohibited by the Guide; had missing, incomplete, or inaccurate information; or did not meet print size requirements. Nearly half of the materials reviewed were confusing or contained jargon. For example, none of the sales brochures reviewed explained accurately or completely the difference between managed care and fee-for-service Medicare. Ninety percent of subscriber agreements conveyed missing, incomplete, or inaccurate descriptions of the appeal process. The OIG recommends that HCFA (1) update the National Marketing Guide to include model materials; (2) require plans to use standardized marketing materials developed by HCFA; (3) develop standard review instruments for use by regional offices; (4) meet and review marketing requirements with plans that continually submit materials that don't comply with federal requirements; (5) train HCFA reviewers on how to use the National Marketing Guide.
The third report concerning extra HMO benefits and the reasons why beneficiaries enroll in a Medicare+Choice plan confirms that beneficiaries seek out but do not always find adequate information to help them compare HMOs. Sixty-three percent of new enrollees who participated in the OIG survey looked at more than one plan before enrolling in an HMO, and almost all compared the extra benefits available. Lower costs were cited by three-quarters of the respondents as the reason for joining the HMO; extra benefits were cited by half of those surveyed. While they also stated that the prescription drug benefit is the most important extra benefit to them, 40% said they are not receiving the kind of drug coverage they expected when they joined their HMO. The OIG found that the sample marking materials reviewed from the plans in which the sample beneficiaries were enrolled were potentially confusing about prescription drug benefits. A few of the plan materials reviewed did not indicate the limits on prescription drug coverage.
Copies of the three OIG reports, Medicare Managed Care - 1998 Marketing Materials, OEI-03-98-00271 (Feb. 2000), Medicare Managed Care- Goals of National Marketing Guide, OEI-03-98-00270 (Feb. 2000), and Medicare+Choice HMO Extra Benefits Beneficiary Perspectives, OEI-02-99B00030 (Feb. 2000), may be downloaded from the Internet at: http://www.dhhs.gov/progorg/oei.
For more information, contact Vicki Gottlich at the Center's Healthcare Rights Project: (202) 293-5760 or vgottlich@centerproject.org.
© Center for Medicare Advocacy, Inc. 05/05/2008