AP File Photo
The Second Opinion

A Post-Dispatch story shows how to help seniors make Medicare decisions

November 13, 2015
AP File Photo

Medicare’s annual open enrollment period—between October 15 and December 7 this year—presents seniors and disabled people with perhaps one of their toughest financial tasks: choosing a plan to cover Medicare’s gaps in coverage for the coming year.

That means it also presents reporters with an opportunity to help Medicare beneficiaries navigate that daunting decision process with reporting that clearly explains the advantages and disadvantages of the main choice before them: Should they remain in the traditional Medicare program and choose a Medigap policy with a stand-alone drug benefit? Or should they choose one of those highly advertised Medicare Advantage plans sold by private insurers paid by the government to provide benefits?

A piece from earlier this month by the St. Louis Post-Dispatch’s Jim Gallagher stands out among coverage so far for carefully walking readers through this fundamental calculation. It’s a calculation, by the way, that “can have long-lasting effects,” a recent Health Affairs study confirms, because beneficiaries tend not to switch from one plan type to another after they make that first choice.

Gallagher begins by explaining the big gaps in Medicare’s coverage and then boiling down for readers the options for covering those gaps—with help from Sandy Leith, head of the Illinois State Health Insurance Assistance Program or SHIP (State Health Insurance Assistance Programs, present in every state, are a good starting point for any Medicare reporting). Writes Gallagher:

Think of it this way, says Sandy Leith, who knows this stuff. With a Medigap policy and Part D [the drug benefit], you pay more now, but less when you’re really sick. With Medicare Advantage, it’s the other way around, says Leith, who heads Illinois’ advice program for Medicare recipients, called SHIP. So, if you think you’ll stay healthy, Medicare Advantage can save you money. If you’re already seeing doctors a lot, Medigap may be better.

Unlike many stories I saw, Gallagher took the time in his piece to quantify the large out-of-pocket maximums that come with Medicare Advantage plans. Gallagher, who did some online shopping for his piece, reported that in St. Louis the out-of-pocket limit could run as high as $6,000, although most are much lower. Gallagher’s piece also stands out because he explained the standardized Medigap plan choices, which offer somewhat different coverage at different price points.

Sign up for CJR's daily email

Much of other reporting I reviewed revolved around the themes of “do your homework” or “shopping tips for saving money.” There’s nothing wrong with that, of course, but too often the advice is vague and glosses over the challenges that shopping around actually entails. For example, this fairly thorough Los Angeles Times piece told seniors who choose Medicare Advantage plans to find out if their doctors are in the network—a crucial question, no doubt—but didn’t convey what an overwhelming task that can be. “It is so hard for consumers to find out,” Tricia Newman, Kaiser’s Medicare expert, told me. “Comparing all plans to see if your cardiologist is in them could take a month.” To better inform their coverage, reporters might try their hand at some of this comparison shopping—as the Post-Dispatch’s Gallagher did.

Another key question for reporters to flag for shoppers: Are your drugs still covered in your plan’s formulary? They may not be. “More drugs are not being covered in the formularies this year,” Troy Filipek, an actuary for Milliman, told me. It’s time-consuming to sift through several plans to check on drug coverage. Medicare’s Drug Finder makes the task easier, and is a resource to which all stories on Medicare enrollment should point. In a recent column for PBS Newshour, Philip Moeller included the drug coverage question in his guide to choosing a Medicare drug plan—and helpfully linked to 2016 formularies for several large insurers. (Moeller’s most most recent column is headlined, notably, “Why is shopping for Medicare so complicated?”)

There’s still time for the press to do some good public service journalism here. Open enrollment continues for a few more weeks, and if those who chose a Medicare Advantage plan want to switch to traditional Medicare, they can still do that until February 14. Judging from the TV ads and mailings that keep coming, the sales season is still in full swing. Seniors need all the help they can get.

Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.