Plan Finder Will Play a Key Role in Part D Redesign

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Summary

Beneficiary interviews show the importance of Medicare Plan Finder as a resource and generated ideas to incorporate IRA reforms and improve user experience.

Background

Medicare Plan Finder was created following the Balanced Budget Act of 1997, which required that the Department of Health and Human Services (HHS) provide Medicare Advantage (MA) plan information electronically. Since then, the Centers for Medicare & Medicaid Services (CMS) has updated Plan Finder to include information on Part D and (much later) Medigap plans. CMS has also modified the website periodically to improve the user experience. Plan Finder is frequently used by Medicare beneficiaries and their caregivers, state health insurance assistance program (SHIP) staff, and aging and health advocacy groups to find MA and Part D plans and estimate plan and drug costs.

Passed in 2022, the Inflation Reduction Act (IRA) includes several reforms that will have the biggest impact on Medicare Part D beneficiaries. These reforms include:

  • Part D Redesign: The Part D benefit will include a new $2,000 out-of-pocket (OOP) spending cap, $0 cost sharing for certain vaccines, a $35 insulin OOP cap, and an increase in plan liability.
  • Part D OOP Smoothing: Beginning in 2025, beneficiaries will be able to spread their OOP costs over the course of the plan year.
  • Medicare Negotiation: For a subset of drugs with high Medicare spend that have no generic/biosimilar competition and have been approved for a minimum number of years, HHS will negotiate prices with a defined ceiling.​

These reforms may shift incentives in Medicare Part D, increasing the share paid by plans, while decreasing the share paid by beneficiaries and the federal government. Changes to the Part D program raise the question of if and how Plan Finder will be modified to ensure that beneficiaries and those assisting them can continue to use the tool effectively. To explore whether and how Plan Finder can be improved to incorporate IRA-related changes to Part D, Avalere conducted interviews with SHIP staff and directors, as well as advocates at health and aging advocacy organizations.

Interview Findings

Interviewees noted that Plan Finder is the most useful tool for Medicare beneficiaries to learn about their plan options and drug costs. While some Medicare beneficiaries use CMS’s “Medicare & You” publication, materials produced by SHIPs and similar organizations, brokers, and websites offered by familiar large insurers, interviewees noted that Plan Finder is the most widely used resource. Interviewees indicated that the ability to enter specific medications and project costs by plan and by pharmacy is particularly useful for beneficiaries.

Given the IRA’s impact on the Part D benefit, interviewees highlighted that Plan Finder needs to be updated thoughtfully. Interviewees stated that IRA-related updates to Plan Finder should have a neutral tone and include interactive tools to allow beneficiaries to project monthly drug costs throughout the redesigned Part D benefit. Interviewees noted that many beneficiaries do not fully understand the concept of a drug formulary and how plan and formulary changes will impact them. To assist beneficiaries, interviewees indicated that Plan Finder should clearly indicate whether a drug is covered on a plan formulary and its formulary tier.

Additionally, interviewees suggested that CMS conduct outreach to beneficiaries to highlight how changes to the Part D benefit will affect them and suggest they use Plan Finder to choose the best plan for them. To that end, interviewees stated that CMS should use digital communication tools and social media posts to reach beneficiaries and encourage them to use SHIPs to receive personalized assistance. Respondents noted that over time, Plan Finder has become more accessible and easier to use (though it is still a very limited resource for individuals who have limited English proficiency) and encouraged CMS to continue to prioritize accessibility improvements, including directing Medicare beneficiaries to other resources that offer language assistance.

Interviewees indicated that Part D OOP smoothing should be incorporated into Plan Finder so beneficiaries understand what the program is and how it may affect their drug costs. Additionally, interviewees emphasized the importance of the Plan Finder site linking to plan enrollment materials for OOP smoothing to facilitate enrollment and incorporating estimates of smoothing payments into monthly cost estimates. Interviewees also noted that there is a lack of clarity on how CMS plans to implement the OOP smoothing program, which may impede changes to Plan Finder.

The IRA shifts incentives that may result in plan formulary changes. Respondents noted how under Plan Finder’s current design, beneficiaries may need to toggle between multiple searches to compare drug access considerations across plans. Interviewees also suggested that Plan Finder flag when drug formulary tier placement changes across plan years so beneficiaries have a better understanding of their cost sharing.

To ensure that beneficiaries and those assisting them can compare drug costs and plan options over time, interviewees recommended that CMS update Plan Finder to make it easier to save results. For example, Plan Finder printable comparisons should include the date, and the tool should allow beneficiaries, caregivers, and those providing enrollment support to save beneficiary-specific details to allow helpers to quickly access relevant details. Multiple interviewees discussed how reentering drugs when starting new searches was time-consuming and can decrease the accuracy of plan and drug search results.

Plan Finder should enable beneficiaries to compare all their healthcare coverage options in a detailed, yet clear and digestible way. Interviewees noted the challenge that navigating Medicare coverage poses, and the key role that SHIP counselors and other caregivers can play for those less comfortable with technology. Without a comprehensive assessment of their options for coverage, many beneficiaries may end up enrolled in a plan that does not fully or optimally meet their needs. One interviewee stated, “no other resource offers interactive ways to compare plan options and costs” and discussed the critical role the tool plays for Medicare beneficiaries.

Interviewees also drew attention to the need for beneficiaries to be able to search across both Part D and MA plan types. Interviewees also suggested that Plan Finder should allow beneficiaries to compare MA supplemental benefits across plans and link directly to plan materials explaining the eligibility criteria for those benefits. Additionally, interviewees stated that Plan Finder should include direct links to MA plan directories and enrollment materials for special needs plans.

Finally, interviewees underscored the need to balance updating Plan Finder to reflect IRA changes quickly, while ensuring all information, particularly from MA plans, is accurate and that the website is easy to navigate.

Methodology

Avalere interviewed individuals employed by SHIPs and state- and national-level aging and health advocacy organizations. Interviewees worked across a wide geographic range in the US, including the West, Midwest, South, and East. Interviews followed a pre-determined interview guide. Avalere compiled and analyzed notes and transcripts from six interviews to determine common trends and experiences with Plan Finder.

About Us

Avalere uses our deep policy expertise to help healthcare stakeholders understand the IRA’s impact across the dynamic healthcare environment. To learn more about how Avalere can support you in understanding the implications of the IRA, connect with us.

Funding for this research was provided by the National Association of Nutrition and Aging Services Programs. Avalere maintained full editorial control.

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