Jane G. Leach
Medicare’s revamped prescription plan finder can steer unwitting seniors to coverage that costs much more than they need to pay, according to people who help with sign-ups and other program experts.
Serving some 60 million Medicare recipients, the plan finder is the most commonly used tool on Medicare.gov and just got its first major update in a decade. The Trump administration has hailed the new version with Medicare Administrator Seema Verma saying it will empower beneficiaries to take advantage of their coverage options.
But as open enrollment goes into the home stretch Thanksgiving week, critics say the new tool can create confusion by obscuring out-of-pocket costs that seniors should factor into their decisions.
“I want to make sure people are given the most accurate information and they’re making the best decision because they are the ones stuck with it,” said Ann Kayrish, senior program manager for Medicare at the National Council on Aging, a nonpartisan organization that advocates for seniors and provides community services.
Government programs mixing health care and technology have faced struggles. Despite billions spent to subsidize electronic medical records, getting different systems to communicate remains a challenge. The Obama administration’s launch of HealthCare.gov resulted in an embarrassing debacle when the website froze up the first day.
The leading Democrat on the Senate Aging Committee said he’s hearing concerns from constituents and organizations that assist Medicare beneficiaries. Pennsylvania Sen. Bob Casey said he will ask Medicare to grant seniors who have had problems a second chance to sign up, called a “special enrollment period.”
“It’s obviously an effort that needs a lot more work to meet the legitimate expectations of seniors,” said Casey. “Especially when you launch something new, (it) can go awry. People steered in the wrong direction should get a measure of fairness.”
The Medicare plan finder’s issue stems from a significant change the agency made for 2020.
The plan with the lowest premium now gets automatically placed on top, with the monthly premium displayed in large font.
Medicare’s previous plan finder automatically sorted plans by total cost, not just premiums.
But premiums are only one piece of information.
When out-of-pocket expenses such as copays are factored in, the plan with the lowest total annual cost is often not the first one shown by the plan finder.
It takes extra work for a Medicare enrollee to discover that.
“If they pick the plan based solely on the premium, they are likely getting a plan that could cost them thousands more in a calendar year,” said Christina Reeg of the Ohio Department of Insurance. She heads a program that helps Medicare enrollees try to find the right plan.
In a statement, Medicare said the monthly premium is a cost that consumers understand and will always be an important decision factor.
But the agency also said total cost paid out-of-pocket is at least equally important, if not more so, particularly for people who take prescription drugs—as do most seniors. Medicare said it is testing ways to encourage consumers to look at total costs, such as a pop-up.
The agency said it chose to prominently display premiums because user testing showed that is what consumers are familiar with. The total annual cost is included, but in smaller font.
That’s puzzling to Kayrish. The lowest premium “doesn’t necessarily translate to lowest cost over the year,” she explained.
Consumers using the plan finder first enter their medications and dosages. To get it to find plans by lowest total annual cost, they must take a few more steps, said Kayrish.
After the screen displays initial search results, consumers should look for the drop-down menu on the right of the screen. Next, she said, select the feature that lets you re-sort plans by “lowest drug + premium cost.”
A reporter’s sample search on a list of six medications for high blood pressure, high cholesterol and diabetes returned 29 plans in the Washington, D.C., area, topped by a lowest-premium option for $13.20 a month.
But after re-sorting for the lowest total cost, the best deal was a plan with a monthly premium of $25.80.
When out-of-pocket expenses were factored in, the second plan cost about $5,800 less a year than the initial lowest-premium option the plan finder displayed.
Costs can vary so much because plans have different coverage designs and they don’t pay the same prices to drugmakers.
And Kayrish said there’s another issue: The new plan finder can return options that don’t cover all of a patient’s medications.
If a low-premium plan has very high out-of-pocket costs, it’s a clue that some of your drugs might not be covered. Check plan details.
Some academic experts compared the old and new versions of the Medicare plan finder and confirmed the problems flagged by hands-on users.
Their review also found improvements. Among them:
“The new plan finder is in many ways improved, but it did take a meaningful step backward by not doing more to highlight its most useful output— the total cost estimate,” said Brian McGarry, an assistant professor at the University of Rochester in New York. He’s the lead author of a recent online article about the plan finder for Health Affairs.
Seniors have until Dec. 7 to pick or switch “Part D” prescription drug plans or, if they’re seeking comprehensive medical care through a private insurer, a Medicare Advantage plan. Coverage takes effect Jan. 1.
A Beloit developer looking to build a subdivision west of the Briar Crest neighborhood might find more success than the last prospective developer based on a neighborhood meeting Thursday night.
Zach Knutson of Next Generation Construction hosted the meeting to listen to and answer questions from people who live near the 10-acre site behind Walmart.
There was no consensus among neighbors for or against Knutson’s plan, but there were a lot of questions and—at times—skepticism from residents who want to ensure their neighborhood remains a good place to live.
Dozens of residents packed the Wisconsin Room at the Holiday Inn Express for the meeting.
Knutson said he hopes to build 13 duplexes and 15 single-family homes on the cornfield between Walmart and Briar Crest.
The 15 single-family homes would line up along the east side of Tanglewood Drive, which would end in a cul-de-sac.
The single-family homes would be built to modern trends and would sell in the $280,000 to $290,000 range, Knutson said. There would be a 50-foot buffer between the back lot lines of Briar Crest homes and the back lot lines of the new homes.
The 13 duplexes would line up on the west side of the road, adjacent to Walmart.
Knutson is not yet sure whether the duplexes would be sold as condos or rented out by his company. Many questions centered on things that are currently unknown, such as what rent might cost, what kind of tenants would live there and how the properties would be managed.
Some residents scoffed at the idea of having rental properties in their neighborhood. They were also concerned about increased traffic along Rotamer Road.
Cherek said a traffic study done in 2017 with the previous developer’s proposal showed no changes would have to be made to accommodate 19 five-unit apartments. That conclusion also applies to this lower density project, he said.
Still, some residents insisted a new traffic study be done.
A detention pond where stormwater would flow is planned for the south end of the parcel, Knutson said.
Knutson hopes to start building in spring. Construction time will depend on how long it takes to sell homes.
Before construction can begin, however, Knutson will have to ask the city to rezone the west side of Tanglewood Drive from a single-family residential district to two-family residential district, city Planning Director Duane Cherek said.
Duplexes can be built in a single-family residential district, but only 20% of such lots may be used for duplexes, Cherek said.
A two-family residential district allows up to 50% of homes to be duplexes. The plan commission would have to approve a conditional-use permit to allow all the proposed dwellings on the west side of Tanglewood to be duplexes, Cherek said. The city would also have to change its comprehensive plan before the plan commission could allow rezoning, Cherek said.
The city will require Knutson connect his property to a bike trail easement on the former Devon Drive through the subdivision to connect to the Ice Age Trail, which runs behind Walmart, Cherek said.
The plan would also need city council approval.
This story has been updated to clarify information about the bike trail.
A former White House official said Thursday that President Donald Trump’s top European envoy was sent on a “domestic political errand” seeking investigations of Democrats, stunning testimony that dismantled a main line of the president’s defense in the impeachment inquiry.
In a riveting appearance on Capitol Hill, Fiona Hill also implored Republican lawmakers—and implicitly Trump himself—to stop peddling a “fictional narrative” at the center of the impeachment probe. She said baseless suggestions that Ukraine interfered in the 2016 election bolster Russia as it seeks to sow political divisions in the United States.
Testimony from Hill and David Holmes, a State Department adviser in Kyiv, capped an intense week in the historic inquiry and reinforced the central complaint: that Trump used his leverage over Ukraine, a young Eastern European democracy facing Russian aggression, to pursue political investigations. His alleged actions set off alarms across the U.S. national security and foreign policy apparatus.
Hill had a front-row seat to some of Trump’s pursuits with Ukraine during her tenure at the White House. She testified in detail about her interactions with Gordon Sondland, saying she initially suspected the U.S. ambassador to the European Union was overstating his authority to push Ukraine to launch investigations into Democrats. But she says she now understands he was acting on instructions Trump sent through his personal attorney Rudy Giuliani.
“He was being involved in a domestic political errand and we were being involved in national security foreign policy,” she testified in a daylong encounter with lawmakers. “And those two things had just diverged.”
It was just one instance in which Hill, as well as Holmes, undercut the arguments being made by Republicans and the White House. Both told House investigators it was abundantly clear Giuliani was seeking political investigations of Democrats and Joe Biden in Ukraine, knocking down assertions from earlier witnesses who said they didn’t realize the purpose of the lawyer’s pursuits. Trump has also said he was simply focused on rooting out corruption in Ukraine.
Giuliani “was clearly pushing forward issues and ideas that would, you know, probably come back to haunt us,” Hill testified. “I think that’s where we are today.”
Hill also defended Lt. Col. Alexander Vindman, the Army officer who testified earlier and whom Trump’s allies tried to discredit. A previous witness said Hill raised concerns about Vindman, but she said those worries centered only on whether he had the “political antenna” for the situation at the White House.
The landmark House impeachment inquiry was sparked by a July 25 phone call, in which Trump asked Ukraine President Volodymyr Zelenskiy for investigations into Biden and the Democratic National Committee. A still-anonymous whistleblower’s official government complaint about that call led the House to launch the current probe.
After two weeks of public testimony, many Democrats believe they have enough evidence to begin writing articles of impeachment. Working under the assumption that Trump will be impeached by the House, White House officials and a small group of GOP senators met Thursday to discuss the possibility of a two-week Senate trial.
There still remain questions about whether there will be additional House testimony, either in public session or behind closed doors, including from high-profile officials such as former Trump national security adviser John Bolton.
In what was seen as a nudge to Bolton, her former boss, Hill said those with information have a “moral obligation to provide it.”
She recounted one vivid incident at the White House where Bolton told her he didn’t want to be involved in any “drug deal” that Sondland and Trump’s acting White House chief of staff Mick Mulvaney were cooking up over the Ukrainian investigations Trump wanted. Hill said she conveyed similar concerns directly to Sondland.
“And I did say to him, ‘Ambassador Sondland, Gordon, I think this is all going to blow up,’” she said. “And here we are.”
Hill and Holmes both filled in gaps in previous testimony and poked holes in the accounts of other witnesses. They were particularly adamant that efforts by Trump and Giuliani to investigate the Burisma gas company were well-known by officials working on Ukraine to be the equivalent of probing the Bidens. That runs counter to earlier testimony from Sondland and Kurt Volker, the former Ukraine special envoy, who insisted they had no idea there was a connection.
Holmes, a late addition to the schedule, also undercut some of Sondland’s recollections about an extraordinary phone call between the ambassador and Trump on July 26, the day after the president’s call with Ukraine. Holmes was having lunch with Sondland in Kyiv and said he could overhear Trump ask about “investigations” during a “colorful” conversation.
After the phone call, Holmes said Sondland told him Trump didn’t care about Ukraine but rather about “big stuff,” meaning the “Biden investigation.” Sondland said he didn’t recall raising the Bidens.
During Thursday’s testimony, the president tweeted that while his own hearing is “great” he’s never been able to understand another person’s conversation that wasn’t on speaker. “Try it,” he suggested.
Republicans continued to mount a vigorous defense of Trump. And the top Republican on the panel was undeterred by Hill’s warnings about advancing “fictions” on Ukraine. GOP Rep. Devin Nunes of California said Russian interference in the 2016 election didn’t preclude Ukraine from also trying to swing the election to stop Trump’s presidency.
“That is the Democrats’ pitiful legacy,” Nunes said. He called it all part of the same effort, from “the Russia hoax” to the “shoddy sequel” of the impeachment inquiry.
Hill, the British-born coal miner’s daughter who became a U.S. citizen in 2002, left the White House before the July phone call that sparked the impeachment probe. She worked for both Republican and Democratic administrations and said she joined the Trump White House because she shared the president’s belief that relations with Russia needed to improve.
Still, she was adamant that Russia is gearing up to intervene again in the 2020 U.S. election, declaring: “We are running out of time to stop them.”
She warned that political chaos in Washington plays into Moscow’s hands.
“This is exactly what the Russian government was hoping for,” Hill said. “They would pit one side of our electorate against the others.”
TOWN OF HARMONY
Along Rotamer Road a few miles east of Janesville, hundreds of acres of corn still stand unharvested adjacent to strips of woods and marsh.
Bill Mullen, a farmer who lives along Rotamer Road, already has picked his corn, but many of his neighbors are waiting for the ground to dry in what has been one of the most protracted Wisconsin fall harvests in recent memory.
Mullen, a former deer hunter, is guessing the woods near his farm might be relatively empty of whitetail deer because they are hunkered down in the standing corn.
When the state’s nine-day gun deer season opens Saturday, hunters will take to the patchwork of woods and farmland in southern and central Wisconsin, Rock County included.
Wardens and big game specialists for the state Department of Natural Resources suspect hunters will find deer less accessible because they’ll likely still be hiding in fields of unharvested corn.
What’s also more likely this gun deer season year, DNR officials said, is that hunters will be bumping elbows with farmers working an abnormally late harvest.
DNR deer ecologist Kevin Wallenfang estimated about only 40% of corn throughout Wisconsin has been harvested, compared to the 70% usually harvested by late November.
“That leaves many, many, many thousands of acres of cover out there,” he said.
DNR data show an uptick in the number of deer killed in the gun deer season the last few years. Wallenfang said it’s not clear how significantly more standing corn might impact the total number of deer bagged in the coming days.
DNR hunter safety specialist Jon King said it’s more likely farmers picking corn, not hunting pressure, will be what drives deer into the open.
Mullen said farmers he knows from Janesville to Mauston are itching to get corn and soybeans harvested. If the weather is good, he said, farmers are not likely to sit indoors and wait for Saturday and Sunday—the two heaviest-hunted days of gun deer season—to pass.
Mullen said most farmers who live near him know the people who will be hunting in the woods near standing corn along Rotamer Road. He joked that he would advise neighbors who might be harvesting corn this weekend not to climb out of their machinery wearing “deer-colored” tan coveralls.
“I’d be wearing lots and lots of blaze orange the next few days,” he said.
King points out that if hunters find they’re setting up near farm fields being harvested, they should remember that people are sitting inside the combines, tractors and grain haulers moving around the fields.
“Hunting during the harvest is not something that’s new, but I will say there is a higher volume of corn in the field compared to what’s normal,” King said. “So there should be some special considerations because of that.”
He said that when hunters are adjacent to farming operations, a few key rules of gun safety become paramount.
“People should be certain of their target,” King said. “You have to know what you’re about to harvest.”
He said a lot of animals that aren’t deer can be brown- or tan-colored and could resemble deer from a distance—including dogs, pigs or cows running in the field.
And don’t expect every person outside during the hunt to follow the Mullen’s advice to wear blaze orange.
In the western parts of Rock County, some rural residents in the past have complained about stray bullets from target shooters hitting their houses or other property.
King said hunters should make sure—particularly if they’re set up near fields being harvested—that they’re not firing toward the path of a person or farm vehicle.
“You should keep your finger off the trigger,” King said. “And always be asking yourself, where’s that bullet going to end up?”