Department of Health and Human Services 

OFFICE OF 

INSPECTOR GENERAL 

USE OF NURSING HOME AND MEDIGAP


GUIDES


+“ % 

~w JUNE GIBBS BROWN 

2 Inspector General 

2 

% 

%. # 

>+ MAY 1994

%dya > OEI-04-92-00481
OFFICE OF INSPECTOR GENERAL 

The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, as 

amended, is to protect the integrity of the Department of Health and Human Services’ (HHS) 

programs as well as the health and welfare of beneficiaries served by those programs. This 

statutory mission is carried out through a nationwide network of audits, investigations, and 

inspections conducted by three OIG operating components: the Office of Audit Services, the 

Office of Investigations, and the Office of Evaluation and Inspections. The OIG also informs 

the Secretary of HHS of program and management problems and recommends courses to 

correct them. 

OFFICE OF AUDIT SERVICES 

The OIGS Office of Audit Services (OAS) provides all auditing services for HHS, either by 

conducting audits with its own audit resources or by overseeing audit work done by others. 

Audits examine the performance of HHS programs and/or its grantees and contractors in 

carrying out their respective responsibilities and are intended to provide independent 

assessments of HHS programs and operations in order to reduce waste, abuse, and 

mismanagement and to promote economy and efficiency throughout the Department. 

OFFICE OF INVESTIGATIONS 

The OIGS Office of Investigations (01) conducts criminal, civil, and administrative


investigations of allegations of wrongdoing in HHS programs or to HHS beneficiaries and of


unjust enrichment by providers. The investigative efforts of 01 lead to criminal convictions,


administrative sanctions, or civil money penalties. The 01 also oversees State Medicaid fraud


control units which investigate and prosecute fraud and patient abuse in the Medicaid program.


OFFICE OF EVALUATION AND INSPECTIONS 

The OIG’S Office of Evaluation and Inspections (OEI) conducts short-term management and


program evaluations (called inspections) that focus on issues of concern to the Department,


the Congress, and the public. The findings and recommendations contained in these inspection


reports generate rapid, accurate, and up-to-date information on the efficiency, vulnerability,


and effectiveness of departmental programs.


OEI’S Atlanta Regional Office prepared this report under the direction of Jesse J. Flowers,


Regional Inspector General, and Christopher Koehler, Deputy Regional Inspector General.


Principal OEI staff included:


AtlantaRegion Headquarters


Betty Apt, Temn Leader Tom Noplock


Kimberly Graves, Contractor Barbara Tedesco


Peggy Daniel


Jacqueline Andrews


Josiah Townsel


For additional copies of this report, please contact the Atlanta Regional Office at 404-331 -


5022.

Department of Health and Human Services 

OFFICE OF 

INSPECTOR GENERAL 

USE OF NURSING HOME AND MEDIGAP 

GUIDES 
EXECUTIVE SUMMARY 

PURPOSE 

To determine Medicare beneficiaries’ awareness and use of the Health Care Financing 

Administration’s Guide to Choosing a Nursing Home and Guide to Health Insurance for 

People with Medicare. 

BACKGROUND 

The Office of the Assistant Secretary for Public Affairs, Department of Health and 

Human Services, asked us to examine departmental strategies for distributing various 

reports and publications to ensure they are received by intended users. As part of a 

1993 Medicare beneficiary satisfaction survey, we asked 1257 randomly selected 

beneficiaries about their awareness and use of two Health Care Financing 

Administration (HCFA) booklets that provide guidance to Medicare beneficiaries and 

their families. 

These two booklets guide Medicare beneficiaries on factors to consider when selecting 

(1) a nursing home, and (2) health insurance to supplement Medicare coverage (often 

referred to as Medigap insurance). According to HCFA, both booklets are available 

from local Social Security offices and senior citizen organizations. 

FINDINGS 

Few beneficiaries were aware of or used the HCFA guides 

�	 Nine percent of the beneficiaries surveyed were aware of the Guide ro Choosing 

a Nursing Home, and one percent had used it. 

�	 Fourteen percent of the beneficiaries surveyed were aware of the Guide to 

Health Insurance for People with Medicare, and two percent had used it. 

Benq%iaries who used the booklets found them usefi.d 

Most beneficiarim stated they would use the booklets if thq needed ru.minghome care or 

Medigap insurance 

�	 Eighty-four percent of the beneficiaries surveyed said they would use the Guide 

to Choosing a Nursing Home should they need to select a nursing home. 

.	 Sixty-five percent of the beneficiaries surveyed said they would use the Guide to 

Health Insurance for People with Medicare should they need to obtain or change 

supplemental health insurance. 

i 
RECOMMENDATION 

We recommend that HCFA work with the Social Security Administration (SSA) and 

the Assistant Secretary for Public Affairs to develop a more effective strategy to make 

the guides available to beneficiaries. 

AGENCY COMMENTS 

The Assistant Secretary for Public Affairs (ASPA), Commissioner of Social Security, 

and HCFA Administrator commented on our draft report. Appendix B shows the full 

text of their comments. 

All agreed with our recommendation and have already begun exploring strategies to 

make HCFA guides more accessible to beneficiaries. For example, HCFA and SSA 

staff are working together to determine ways to improve access to Medicare 

information. HCFA staff have also been considering the feasibility of making the 

guides available through hospitals and physicians. ASPA suggests that the Department 

advertise the guides through senior citizen groups and public service announcements. 

ii 
TABLE OF CONTENTS


PAGE 

EXECUTIVE S~y 

lNTRODU~ON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...1 

FINDINGS 

Few Beneficiaries Were Aware of or Used Guides . . . . . . . . . . . . . . . . . . . . . . 

Users Found Guides Helpful.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...3 

Beneficiaries Are LikelytoUse GuidesWhenNeeded . . . . . . . . . . . . . . . . . . . 

RECOMMENDATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

APPENDICES 

5 

4 

5 

A-1 

Responses toSu~ey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Agency Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1 
INTRODUCTION


PURPOSE 

To determine Medicare beneficiaries’ awareness and use of the Health Care Financing 

Administration’s Guide to Choosing a Nursing Home and Guide to Health Insurance for 

People with Medicare. 

BACKGROUND 

The Office of the Assistant Secretary for Public Affairs, Department of Health and 

Human Services, asked us to examine strategies used by agencies in the Department 

to ensure that reports and publications are received by intended users. As part of a 

1993 Medicare beneficiary satisfaction survey, we asked 1257 randomlyselected 

beneficiaries about their awareness and use of two Health Care Financing 

Administration (HCFA) booklets that provide guidance to Medicare beneficiaries and 

their families. 

Medicare Guides 

HCFA publishes two booklets to guide Medicare beneficiaries in selecting (1) a 

nursing home, and (2) health insurance to supplement Medicare coverage (often 

referred to as Medigap insurance). 

The Guide to Choosing a Nursing Home was first published in 1991. The booklet 

contains information on (1) factors to consider in selecting a nursing home, and (2) 

Medicare and Medicaid coverage of nursing home care. 

The Guide to Health Insurance for People with Medicare was first published in 1979


and most recently revised in 1992. The booklet provides information on (1) Medicare


coverage, (2) types of Medigap policies, and (3) tips for purchasing Medigap coverage.


According to HCFA, both booklets are available from HCFA, local Social Security


offices, and senior citizen organizations. The Guide to Health Insurance for People with


Medicare is also available from State insurance departments, and through the


Medicare Handbook. The Medicare Handbook instructs beneficiaries on how to


order the health insurance guide, The Medicare Handbook is issued to all


beneficiaries when they enroll in Medicare.


Medicare l?ogram 

Medicare is a Federal health insurance program for individuals age 65 and older and 

for certain categories of disabled people. Authorized in 1965 by title XVIII of the 
Social Security Act, Medicare paid benefitsin 1992 totalling $129 billionth 

approximately 35.5 million beneficiaries.1 

Within the Department of Health and Human Services, HCFA has responsibility for 

administering the Medicare program. 

METHODS 

As part of a 1993 survey to determine beneficiary satisfaction with Medicare; we 

asked beneficiaries about their awareness and use of HCFAS Guide to Choosing a 

Nursing Home and Guide to Health Insurance for People with Medicare. Appendix A 

shows responses to these questions. 

In February 1993, we mailed a questionnaire to 1257 randomly selected beneficiaries 

for whom Medicare Part B claims had been filed in Calendar Year 1991. Based upon 

previous experience with similar client and beneficiary surveys, the sample size was 

calculated to produce an estimate within 3.5 percent of the true value at the 95 

percent confidence level. We used standard equations for estimating sample size with 

a binary response variable. 

Beneficiaries’ participation in the survey was voluntary. A total of 1053 beneficiaries 

returned completed questionnaires, for a response rate of 84 percent. Given the size 

of our sample and response rate, results of the survey are protectable to the universe 

of 35 million Medicare beneficiaries. Percentages in the report are based on the 

number of respondents answering each question. 

We conducted this inspection in accordance with the Quality Standards for Inspections 

issued by the President’s Council on Integrity and Efficiency. 

lHealth Care Financing Administration, HCFA Statistics,September 1992 

20ffice of Inspector General, United States Department of Health and Human Services. Medicare 

Beneficiary Satisfaction: 1993. 0EI-04-92-O0480. 

2 
FINDINGS 

FEW BENEFICIARIES WERE AWARE OF OR USED THE HCFA GUIDES 

Table 1 shows that less than 15 percent of the beneficiaries surveyed knew about the 

booklets HCFA publishes to guide them in selecting nursing homes and Medigap 

insurance. Only two percent or fewer of the beneficiaries surveyed had ever used 

either of the guides. 

TABLE 1


KNOWLEDGE AND USE OF HCFA GUIDES


Guide to Choosing a Nursing Home 9% 170 

Guide to Health Insurance for People 1470 2% 

withMedicare 

BENEFICIARIES WHO USED THE GUIDES FOUND THEM USEFUL 

All seven of the beneficiaries who had used the Guide to Choosing a Nursing Home


said they found the booklet helpful. Twenty-two of 24 beneficiaries who had used the


Guide to Health Insurance for People with Medicare said they found the booklet


helpful. Two users of the health insurance guide did not answer the question about


usefulness. No beneficiary said either booklet was not useful.


3

BENEFICIARIES STATED THEY WOULD USE THE GUIDES IF THEY 

NEEDED NURSING HOME CARE AND MEDIGAP INSURANCE 

We asked all the beneficiaries surveyed if they would be likely to use the booklets if 

they had a need to (1) obtain nursing home care, or (2) obtain or change Medigap 

insurance. Table 2 shows that more beneficiaries would be likely to use the nursing 

home guide than the guide for selecting Medigap insurance. 

TABLE 2 

POTENTIAL USE OF HCFA GUIDES 

! Guide to Choosing a Nursing Home I 84% II 

Guide to Health Insurance for People 65% 

wi~hMedicare 

4

� 

RECOMMENDATIONS


The guides are available from several sources, including Social Security offices, but at 

least 85 percent of Medicare beneficiaries do not know about them. Thus, they 

cannot benefit from the guidance on selecting nursing homes and Medigap insurance 

when needed. If a larger number of beneficiaries who needed assistance knew of the 

guides, use would likely increase. 

We recommend that HCFA work with the Social SecurityAdministration(SSA) and 

the AssistantSecretaryfor Public Affairs to develop a more effective strategyto make 

the booklets availableto all beneficiaries. 

The availability of these guides should be publicized to both beneficiaries and their 

families. Some potential ways that could increase awareness of the guides are 

mentioned below. 

�	 Since most beneficiaries see physicians, and family members often take them, 

a list of HCFA guides could be distributed through physicians. 

�	 Carriers could include a listing of HCFA guides with the Explanation of 

Medicare Benefits sent to beneficiaries after claims for Part B services have 

been processed. 

.	 In locations where Peer Review Organizations conduct town meetings, they 

could distribute lists of HCFA guides to attendees. 

� The Medicare Handbook could list all HCFA guides, not just a selected few. 

Post offices could display lists of HCFA guides. 

5


— 
AGENCY COMMENTS


The Assistant Secretary for Public Affairs (ASPA), Commissioner of Social Security, 

and HCFA Administrator commented on our draft report. Appendix B shows the full 

text of their comments. 

All agreed with our recommendation and have already begun exploring strategies to 

make HCFA guides more accessible to beneficiaries. For example, HCFA and SSA 

staff are working together to determine ways to improve access to Medicare 

information. HCFA staff have also been considering the feasibility of making the 

guides available through hospitals and physicians. ASPA suggests that the Department 

advertise the guides through senior citizen groups and public service announcements. 

6

APPENDIX A


RESPONSES TO 1993SURVEY OF MEDICARE BENEFICIARIES 

Not every respondent answered every question. Percentages are based on actual 

responses. The number of respondents not answering an individual question is not 

included in the calculation of percentages. 

Question Responses Percentage 

1.	 Medicare publishesa booklet entitled “Guide to Choosing a Niusing Home.” It 

discussesthingsto look for in selectinga nursinghome, and is availablefrom 

several offices, includingyour Social Securityoffice. 

Before today, were you aware Medicare had information on choosing a nursing 

home? 

YES 93 9 

NO 917 91 

NO ANSWER: 43 

2. Have you ever used the booklet to help you select a nursinghome? 

YEs 7 1 

NO 83 8 

I DID NOT KNOW MEDICARE 

HAD A BOOKLET ABOUT 

CHOOSING NURSING HOMES 917 91 

NO ANSWER: 46 

3. Was the booklet helpful? 

YEs 7 1 

NO o 0 

I HAVE NOT USED THE BOOKLET 1002 99 

NO ANSWER: 44 

A-1

Question Responses Percentage 

4.	 Now thatyou know about the bookletj are you likelyto use it if you should need 

to select a nursinghome? 

YEs 805 84 

NO 149 16 

NO ANSWER: 99 

5.	 Medicare also has a booklet entitled “Guide to Health Insurance for People with 

Medicare.” It discussesthingsyou should look for in choosing Medigap insurmce 

to supplementyour Medicare coverage. IL too, is availableat your Social Security 

office. 

~, were you aware Medicare had a booklet to help you choose other 

health insurance? 

YEs 139 14 

NO 875 86 

NO ANSWER: 39 

6. Have you ever used the booklet to help you select health insuranceto supplement 

your Medicare? 

YEs 

NO 

I DID NOT KNOW MEDICi%RE 

HAD A BOOKLET ABOUT 

CHOOSING OTHER 

HEALTH INSURANCE 

NO ANSWER: 40 

7. Was the booklet helpful? 

YES


NO


I HAVE NOT USED THE


BOOKLET 

NO ANSWER: 23 

24 2 

114 11 

875 87 

22 2 

0 0 

1008 98 

A-2

Question Responses Percentage 

8.	 Now that you know Medicare has a booklet to help you choose health insurance, 

are you likely to use it should you wish to purchase health insurance to 

supplement your Medicare or to change your current supplemental policy? 

YEs 618 65


NO 338 35


NO ANSWER: 97


A-3

APPENDIX B 

AGENCY COMMENTS 

� Assistant Secretary for Public Affairs 

� Commissioner of Social Security 

� Administrator, Health Care Financing Administration 

B-1 
*Y’-­
 ~
 [~ DEPARTMENT OF HEALTH& HUMAN SERVICES Officeofthe Aaaiatant Sacfataw

for Public Affaira 

L 4 Washington, D.C. 20201 

November 12, 1993 

To: Bryan Mitchell, principal Deputy InSpf=Ctor” General . 

From: Avis LaVelle, Assistant Secretary for Public Affairs & , 

Re: OIG Draft Report: “Use of Nursing Home and Medigap 

Guidest’ @/- ~~~j. 1 ,Z, ~ , 

After learning of the woeful underutilization of HCFA4S Medigap 

and Nursing Home Guides, I offer these suggestions: 

1.	 Secretary Shalala, HCFA Director Bruce Vladeck and Fernando 

Torres-Gil, Assistant Secretary for Aging should send 

out a joint communique to Senior Citizen Groups and 

publications urging the use of these guides. 

2.	 Secretary Shalala, in conjunction with some commemorative 

occasion (such as National Senior Citizens month) 

should do public service announcements for radio and 

television for di.stributi.on to commercial and cable 

stations particularly in geographic regions heavily 

populated by seniors. 

3.	 We should look for news events or stories that provide the 

opportunity for publicizing the use of both of these 

guides (for example, a report on a study that indicates 

the growing number of nursing home residents or a 

report of the soaring cost of health care for the 

elderly) . Stories such as these would provide a news 

hook for Vladeck, Torres-Gil and/or Shalala to do 

interviews on resource material that is available to 

guide the decisions being made with respect to those 

topics. 

4.	 The American Association of Retired Persons (AARP) has a 

newsletter that serves an estimated 30 million senior 

citizens around the country and a radio network that is 

carried in dozens of markets nationwide. Both would 

provide opportunities for widespread dissemination of 

information on these consumer guides. 
--

--

Admhl*tr8Mn DEPARTMENT OF HEALTH 6LHUMAN SERVICES 8oGld Security

Refer !0 Memorandum . m 25 1994 

Shirley S. Chater =ZZa$&ti 

Commissioner of Social Secu ty 

~ffice of Xnspector General Draft Report, ‘We of N~siw Home Subjecl: and Medigap Guides,” (OEI-04-92-00481)--INFORMATION 

To: “	June Gibbs Brown


Inspector General


L> 

‘-. , k 

Attached is our response to the subject report. If we can be


of further assistance, please let Us knC3W.


Attachment:


SSA Response


=& 

c­

,. 

.-

4. 

-: 
.
 office 13fInsDeetar General -~ lumo~


We recmnmend that tha Health Cara Finance Adminiatratim (HCFA) 

work with the Social Security Administration and the Assistant 

Secratary for Public Affairs to develop a strate to more 

affectively make the guides available to benefitFarhs. 

88A cam elat 

We appreciate the opportunity to ccmment on the draft report. 

We will be happy to work with JiC!~A in any strategy development it 

undertakes for publicizing the availability of the guides to 

beneficiaries and their family members. 
� hed’ttl “am 8--:’
DEPARTMENT OF HEALTH& HUMAN SERVICES FinerIcing AdministM’tIon ~ 

a 

‘L 4 Memorandum 

- offiw of ~ec~or &ne~ (OIG) D* R~por& ~se of Nursing Home and 

Medigap Guides” (OEI-04-92-~81) 

To 

June Gibbs Brown 

Inspector General 

We reviewed the above-referenced report in which OIG found that a significant 

number of beneficiaries are not aware of nursing home and Medigap guides that the 

Health Care Financing Administration (HCFA) publishes to help them make more 

informed decisions about their health care. 

We concurwiththerecommendationthatHCFA work with the Social Security 

Administration and the Assistant Secretary for Public Affairs to develop a more 

effective strategy to make the booklets available to all beneficiaries. We also concur 

with most of the suggestions for ways to increase awareness of Medicare publications. 

Thank you for the opportunity to review and comment on this draft report Our 

detailed comments on the report’s findings and recommendations are attached for 

your consideration. Please advise us if you would like to discuss our mmments at 

yourearliest
 convenience.


Attachments 
Recornmendation 

“We recommend that HCFA work with the Social Security A~ tion (SSA) and 

the Office of the As&ant Secretary for Public Affairs (OASPA) to develop a 

strategy to more effectively make the booklets available to all beneficiaries.” 

HCFA Remonse 

We concur with the recommendation to work with SSA and OASPA to impruve our 

dissemination of information to beneficiaries We believe these recommendations 

complement a ntimber of ongoing HCFA initiatives. Some examples are: 

o	 HCFA and SSA have established a work group of Senior Staff members who 

meet quarterly to discuss ongoing issues in an effort to improve coordination 

and dissemination of information and other operational initiatives. 

0	 HCFA staff recently visited an SSA District Office to get firsthand feedback 

from representatives on ways to improve expanded access to HCFA System$ 

andprovide needed information to SSA staff on Medicare programs so they 

can assistour beneficiaries more effectively. 

0	 HCFA and SSA staffs are currently exploring the feasibility of an inmmgenq 

agreement with the U.S. Postal Service, the Veterans Admin@a tion, and the 

Internal Revenue Service to develop a prototype kiosk which could potentially 

contain Medicare/Medicaid and Social Security information, including -

information currently contained in our guides and publications. 

0	 We are also working with OASPA to learn more about the expertise they can 

provide to HCFA to enhance and improve our media relations and capabilities 

to communicate with our beneficiaries. In addition, we submit all proposed 

publications developed by HCFA to OASPA for review and clearance. 

We believe that continuous improvement and feedback are necesswy requirements to 

effectively meet our customers’ needs. Therefore, HCFA intends to seek direct input 

from beneficiary action groups, e.g., the American Association of Retired Persons 

(-), as we revise and improve our products and broaden the base of contacts 

who can disseminate our publications. 
Page 2 

With respect to the suggestionsfor ways to increase public awareness of HCFA’S 

guid~ we offer the following camments. 

OIG Sumzestion 

Since most beneficiaries see physici~ and family members often take them, a list of 

HCFA guides could be distributed through physicians. 

HCFA Resuonse 

The report indicates thatthephysician’s office isa convenient location
 for


disseminating tobeneficiaries a list ofavailable
 HCFA publications and guides. We 

have recently completed a series of focus groups which dealt in part with 

beneficiaries’ knowledge and understanding of HCFA programs through use of our 

various publications. Coincidently, one of the recomm endations of the focus groups 

is to distribute information through physicians’ offices. 

As a result of the findings from the focus groups and recommendations for 

improvernen~ we are developing a project to reevaluate our series of publications 

with respect to their usefulness, conten~ and design in an effort to maximize their 

potential in the most cost-effective manner. In addition, we are looking at a number 

of other ideas to improve the distribution and availability of our publications. We 

believe distribution of information through physicians’ offices to be a valid 

consideration. 

In addition to distribution to physician% HCFA will also consider the feasibility of 

making guides available to beneficiaries through hospital personnel. Because 

Medicare pays for nursing home care only when it follows a hospital stay,we believe 

most persons become aware of their need for this information as they approach 

discharge from a hospital. 

OIG Sumzestion


Carriers could include a listing of HCFA guides with the explanation of Medicare


benefits sent to beneficiaries after claims for Part B SeMCeS have been processed.


HCFA Remonse


Prior experiences have shown that adding information to the Explanation of


Medicare Benefits confuses beneficiaries. We believe mat utilizing the Medicare


Handbook as a vehicle to disseminate information regarding a list of HCFA


~ubiic3t53ns is a pmferabie abnative. TM Medicare Flam%cok 5 se3t % newiy


entitled beneficiaries as weu as those who request the pub~~tion. ~~A believes it.


can effectively reach its customeri using an existing mechanism.

. . 

Page 3 

OIG Suzzestion 

In locations where Peer Review Organizations (PROS) conduct town meeting&they 

oould distribute lists of HCFA guides to attendees 

HCFA Rcxmonse 

HCFA currently distributes publications to PROS for use at town meetings. We are 

in the process of disseminating up to 1,000 copies of the Medicare Handbook and 

Guide to Health Insurance to the PRO in North Carolina for an upcoming meeting. 

We will explore increasingthe utilization of this avenue for dissemination and 

communication. 

OIG Swwestion , 

The Medicare Handbook could list all HCFA guides not just a select few. 

HCFA Resoonse 

HCFA will evaluate adding a complete listing of all HCFA guides in the Medicare 

Handbook. 

OIG Suwzestion 

Post offices could display lists of HCFA guides. 

HCFA Remonse 

HCFA will be broadening the scope of organizations to consider post offices and 

other public places that can disseminate publications as we continue to improve our 

communications with beneficiaries. 

TECHNICAL COMMENTS 

The report does not recognize that every insurer selling health insuranoe or accident 

or sickness insurance that provides hospital or medical expense caverage to elderly 

Medicare beneficiaries is required to deliver to all prospective buyers a copy of the 

Medigap Buyers Guide (the Guide), which was jointly developed by ~CFA and the 

National Association of Insurance Commissioners (NAIC). This quirement is 

contained in section 16 of the lWLICmodel regulation for Medigap policies. The 

hLUC model regulation is incorporated by reference into section 1882 of the Social 

Securiiy Act [the Act). Therefore, it has the force of Federal law. Section 1182 of 

the Act requires alI States to have in force Medigap standards that are at least as 

stringent as those contained in the NAIC model regulation. 
, 

Page 4 

Given this requiremen~ and the fa~ that appr~ate~ 75 percent of ben*&iaries 

have some type of insurance to supplement Me&~ it is puzzling to us that the 

Guide is so little known to benefitia,ri~ HCF’A believes that bene&cia&s may not 

-gnize the Guide they receive horn the insurer as a HCFA publicati~ because 

most insurers either obtain camera ready copies of the Guide and reproduce their 

own copies or reprint the text in another format wtich is required to be cmsistent 

with the NAIC modek Because insurers attach their own logo to the Guide, many 

purchasersmay be unaware that the Guide in this fornq is a HCFA publication. 

Additionally, the insurers may not be compl@g with tie NAIC requirement which 

eve~ State should enforce as part of its Medigap regulatory program. Although 

insurers are required to deliver the Guide to prospective buye~ HCFA has no way 

of knowing whether they actually comply with the law, since enforcement is a State 

responsibility. 

During the exit conference, it was mentioned that the average age of the beneficiary 

surveyed was between 73 and 74. We have found that benefitities in the 65-68 age 

group are more likely to be faced with the decision about whether to purchase 

Medigap insurance (i.e., because they are ceasing work and m-g decisions about 

Medicare Part B coverage at this time). 

Since the time that the beneficiaries were surveye~ there has been increased 

outreach by the AMRP and the Health Insuran~ In.formatio~ Counseling and 

kistance (ICA) programs. ICA was created by the Omnibus Budget Reconciliation 

Act of 1990 and funded for Fiscal Years 1992 and 1993. This grant programfunds 

all the States to provide information to Medicare beneficiaries. The Guide to Health 

Insurance for People With Medicare is one of the required publications for this 

program. A Guide to Selecting a Nursing Home is an optional publication for use by 

the States. These State ICA programs provide one mech- for dissemination of 

these and other pamphlets as well as one-on-one cxmnseli.ngfor questions. 

Beneficiaries who were in the 65-68 age group at the time the survey was conducted 

have received additional counseling and information. Because these improvements 

took effect after the study’s cornpletio~ HCFA believes that if another sunwy was 

conducted the results would be more favorable. These ICA programs are now part 

of HCFA’Sstrategy for information dissemination. 

If such a survey is reconducte~ we would fid it helpful if the stmey asks the 

interviewees whether they had ever purchased or applied for any Medigap or health 

insurance policy to supplement their Medicare coverage and whether they had 

received a copy of the Guide from the insurer at the time of the purchase. 
Page 5 

We believe a sample cmrfined to recent purchasers of Medigap insurance would alSO 

give us more reoent data on whether they used the Guide in their pumhase deoision. 

We believe the same is true with regard to the nursing home guide. ‘Xl&booklet is 

only relevant to the beneficiary when they need to make suoh a decision. In any 

future restweying, we suggest OIG ask providers and discharge planners if they are 

disseminating the Guide for Nursing Homes at probable decision points 

EDITORXAL COMMENTS 

k the recommendation sentence on page ii and page 5 of tie repo~ we suggest that 

the phrase “to develop a strategy to more effectively make the guides available” be 

changed to, “to develop a more effective strategy to make the guides available.” 

The word “guide”should be inserted after HCFA on page 5, the third bullet item.