Medicare Part D: Opportunities Exist for Improving Information Sent to Enrollees and Scheduling the Annual Election Period

GAO-09-4 Published: Dec 12, 2008. Publicly Released: Dec 12, 2008.
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Highlights

In Medicare Part D, enrollees in stand-alone prescription drug plans (PDPs) are allowed to switch plans during an annual coordinated election period (AEP) set under law from November 15 to December 31, with new coverage effective January 1. The Centers for Medicare & Medicaid Services (CMS) required that plan sponsors send an Annual Notice of Change (ANOC)--using either its model or a nonmodel format--before the 2008 AEP. Among other things, GAO examined: (1) stakeholders' views of the model ANOC and CMS's efforts to assure its effectiveness, and (2) how the scheduling of the AEP affects the enrollment process for beneficiaries switching PDPs. Among the largest PDP sponsors, we selected eight to interview along with other stakeholders involved in the AEP. We also obtained and analyzed data from CMS.

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Recommendations

Matter for Congressional Consideration

Matter Status Comments
To improve the Part D enrollment process, Congress may wish to consider authorizing the Secretary of HHS to amend the current AEP schedule to include a sufficient processing interval to fully enroll beneficiaries prior to the effective date of their new coverage.
Closed – Implemented
The Patient Protection and Affordable Care Act amended the schedule for the Part D annual election period.

Recommendations for Executive Action

Agency Affected Recommendation Status
Centers for Medicare & Medicaid Services To ensure that beneficiaries are informed effectively of plan changes, the Acting Administrator of CMS should strengthen the agency's evaluation of the Annual Notice of Change-Evidence of Coverage (ANOC-EOC) by reviewing alternative formats that include personalized drug coverage and cost information.
Closed – Implemented
In its response to our request for follow-up, CMS reported that the recommendation in our report has been implemented. In addition, on June 1, 2011 CMS officials distributed a memo on the model marketing materials for 2012. In it they wrote of their important revisions to the ANOC template to improve communications. Notably, the agency created nine alternative ANOC templates to better accommodate the unique features of the various drug plans. CMS officials wrote that these templates incorporated comments from consumer advocacy groups, plan sponsors and health plan associations. They highlighted the use of plain language, the removal of three pages of duplicative information as well as minor changes in the presentation of cost information. According to CMS officials, the agency conducted two rounds of consumer testing and listening sessions with stakeholders and consumer advocates and condensed language in the new ANOC templates to ensure relevant content in each section. The agency reported that it will continue to evaluate existing communications for their effectiveness.

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