Some plans choose to disclose the benefits in greater detail, but some plans merely provide a brief summary with a disclaimer telling the beneficiaries they must request full disclosure. Many beneficiaries rely on the verbal assurances they receive from marketing representatives that a benefit is covered. Summaries are useful and assistance from plan representatives is essential, but this should not be the only way beneficiaries are told of their benefits. When information is inadequate or misleading, this leads to confusion and in some instances an appeal by the beneficiary over what is covered or not covered by the plan. To further add to their confusion, enrollees are not given a clear or consistent description of the appeals process, leaving them feeling helpless and alone.
Many beneficiaries believe their only alternative is to disenroll from the plan.
This is costly and time consuming for everyone involved and as our witnesses will tell us, is not always their preferred choice. It is often the case that when seniors leave traditional Medicare for a managed care plan, they believe they are no longer in Medicare. Their inability to identify their MedicarePlusChoice plan as being part of Medicare can often lead to confusion and a misunderstanding of what they are entitled to under the program. We will hear from two Medicare enrollees this afternoon who will describe how their difficulties in obtaining the kind of useful and reliable information and assistance they needed reeked havoc on their lives. We will also hear from a representative from a State Health Insurance Program, which I will refer to as SHIP, who will testify about her experiences assisting Medicare beneficiaries through the maze and confusion of understanding their benefits and their rights to appeal when problems arise.