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Dual Eligible Americans Need Support During Medicare Open Enrollment

Improvements to the Plan Finder online tool can help the 12 million Americans who qualify for both Medicare and Medicaid navigate a potentially overwhelming experience.

Image of health professional reviewing information with senior couple.
(skynesher/ Getty Images)

Medicare’s annual open enrollment season is upon us again. It’s a time when people who are eligible for Medicare coverage can examine their coverage choices and select an option. 

This can be an incredibly overwhelming experience for those who are Medicare-eligible. 

First, there’s the marketing. Open enrollment means being inundated by direct calls and mail, through online ads and commercials, all of which encourage recipients to pick different coverage options. This proliferation of information can be confusing and, in some cases, violates federal regulations. The proliferation of deceptive practices even led the Senate Finance Committee to hold a hearing on the topic. 

Beyond the marketing, there’s also the staggering number of decisions. Depending on where someone lives, individuals eligible for Medicare can have 100 or more coverage options to choose from.

All of this makes for a chaotic process that doesn’t always result in individuals enrolling in their best possible option. 

Improving Plan Finder for the Dually Eligible

While the government can and should do more to curb marketing tactics that increase confusion and streamline the number of coverage options available, it can also help beneficiaries by improving an online tool called Plan Finder. 

Plan Finder was created to help people interested in enrolling in a Medicare Advantage or prescription drug plan navigate the maze of coverage options available to them based on factors they care about. For example, people can sort coverage options by cost, quality, and insurance company. 

However, for 12 million people who are eligible for Medicaid on top of their Medicare coverage – the dual-eligible” population – this tool falls short of its promise and can create even more confusion. 

We really need to improve Plan Finder and other sources of information to ensure people can make informed decisions about their health insurance coverage.
Arielle Mir vice president of health care, complex care for arnold ventures

People who are dual-eligible often have very low incomes and frequently live with chronic conditions and disabilities. This means they are more likely to use their health insurance coverage than those who are not dual-eligible, making selecting the right coverage option all the more important. 

Medicare Advantage plans often attract enrollees due to their zero-dollar premiums, low co-pays, or extra benefits like vision and dental. These are features that traditional Medicare doesn’t offer, and that’s part of the reason why Plan Finder displays results and allows people to sort based on these factors. 

However, if you’re dual-eligible for Medicare and Medicaid these factors are likely irrelevant. People who are dual-eligible pay little to nothing in cost sharing and premiums for their Medicare coverage. 

They also may have access to Medicaid benefits, such as vision and dental coverage. However, none of this is clear when shopping on Plan Finder today. 

Prioritizing D‑SNP

What’s more, a special kind of Medicare Advantage plan, called a dual-eligible special needs plan (D‑SNP) was created specifically for the dual-eligible population. Because it is targeted, this type of plan focuses more on enhancing the Medicaid benefits that people who are dual-eligible already receive rather than overlapping with them. These plans also are required to coordinate with people’s Medicaid coverage, so the two feel more like a single program to those enrolled. 

Despite the potential benefits, these D‑SNP plans aren’t prioritized on Plan Finder and the value of enrolling in one of these coverage options isn’t clear to the people using the Plan Finder tool to understand their coverage options. 

We make it way too hard for people,” Arielle Mir, vice president of Arnold Venture’s complex care team said, We really need to improve Plan Finder and other sources of information to ensure people can make informed decisions about their health insurance coverage.” 

To highlight potential solutions, Arnold Ventures along with several other organizations recently sent a letter urging improvements to Plan Finder. You can read the letter below.