Within the past 6 months, millions of Medicare beneficiaries have been making important decisions about their prescription drug coverage and have needed access to information about the new Part D benefit to make appropriate choices. CMS faced a tremendous challenge in responding to this need and, within short time frames, developed a range of outreach and educational materials to inform beneficiaries and their advisers about Part D. To disseminate these materials, CMS largely added information to existing resources, including written documents, such as Medicare & You; the 1-800-MEDICARE help line; the Medicare Web site; and support for SHIPs. However, CMS has not ensured that its communications to beneficiaries and their advisers are provided in a manner that is consistently clear, complete, accurate, and usable. Six months have passed since these materials were first made available to beneficiaries, and their limitations could result in confusion among those seeking to make coverage decisions. Although the initial enrollment period for Part D will end on May 15, 2006, CMS will continue to play a pivotal role in providing beneficiaries with information about the drug benefit during the year and in subsequent enrollment periods. CMS has an opportunity to enhance its communications on the Part D benefit. This would allow beneficiaries and their advisers to be better prepared when deciding whether to enroll in the benefit, and if enrolling, which drug plan to choose. In order to improve the Part D benefit education and outreach materials that CMS provides to Medicare beneficiaries, we are recommending that the CMS Administrator take the following four actions: Ensure that CMS’s written documents describe the Part D benefit in a manner that is consistent with commonly recognized communications guidelines and that is responsive to the intended audience’s needs. Determine why CSRs frequently do not search for available drug plans if the caller does not provide personal identifying information. Monitor the accuracy and completeness of CSRs’ responses to callers’ inquiries and identify tools targeted to improve their performance in responding to questions concerning the Part D benefit, such as additional scripts and training. Improve the usability of the Part D portion of the Medicare Web site by refining Web-based tools, providing workable site navigation features and links, and making Web-based forms easier to use and correct. We received written comments on a draft of this report from CMS (see app. III). CMS said that it did not believe our findings presented a complete and accurate picture of its Part D communications activities. CMS discussed several concerns regarding our findings on its written documents and the 1-800-MEDICARE help line. However, CMS did not disagree with our findings regarding the Medicare Web site or the role of SHIPs. CMS also said that it supports the goals of our recommendations and is already taking steps to implement them, such as continually enhancing and refining its Web-based tools. CMS discussed concerns regarding the completeness and accuracy of our findings in terms of activities we did not examine, as well as those we did. CMS stated that our findings were not complete because our report did not examine all of the agency’s efforts to educate Medicare beneficiaries and specifically mentioned that we did not examine the broad array of communication tools it has made available, including the development of its network of grassroots partners throughout the country. We recognize that CMS has taken advantage of many vehicles to communicate with beneficiaries and their advisers. However, we focused our work on the four specific mechanisms that we believed would have the greatest impact on beneficiaries—written materials, the 1-800-MEDICARE help line, the Medicare Web site, and the SHIPs. In addition, CMS stated that our report is based on information from January and February 2006, and that it has undertaken a number of activities since then to address the problems we identified. Although we appreciate CMS’s efforts to improve its Part D communications to beneficiaries on an ongoing basis, we believe it is unlikely that the problems we identified in this report could have been corrected yet given their nature and scope. CMS raised two concerns with our examination of a sample of written materials. First, it criticized our use of readability tests to assess the clarity of the six sample documents we reviewed. For example, CMS said that common multisyllabic words would inappropriately inflate the reading level. However, we found that reading levels remained high after adjusting for 26 multisyllabic words a Medicare beneficiary would encounter, such as Social Security Administration. CMS also pointed out that some experts find such assessments to be misleading. Because we recognize that there is some controversy surrounding the use of reading levels, we included two additional assessments to supplement this readability analysis—the assessment of design and organization of the sample documents based on 60 commonly recognized communications guidelines and an examination of the usability of six sample documents, involving 11 beneficiaries and 5 advisers. Second, CMS expressed concern about our examination of the usability of the six sample documents. The participating beneficiaries and advisers were called on to perform 18 specified tasks, after reading the selected materials, including a section of the Medicare & You handbook. CMS suggested that the task asking beneficiaries and advisers to calculate their out-of-pocket drug costs was inappropriate because there are many other tools that can be used to more effectively compare costs. We do not disagree with CMS that there are a number of ways beneficiaries may complete this calculation; however, we nonetheless believe that it is important that beneficiaries be able to complete this task on the basis of reading Medicare & You, which, as CMS points out, is widely disseminated to beneficiaries, reaching all beneficiary households each year. In addition, CMS noted that it was not able to examine our detailed methodology regarding the clarity of written materials—including assessments performed by one of our contractors concerning readability and document design and organization. We plan to share this information with CMS, once our report has become public. Finally, CMS took issue with one aspect of our evaluation of the 1-800-MEDICARE help line. Specifically, CMS said the 41 percent accuracy rate associated with one of the five questions we asked was misleading, because, according to CMS, we failed to analyze 35 of the 100 responses. However, we disagree. This question addressed which drug plan would cost the least for a beneficiary with certain specified prescription drug needs. We analyzed these 35 responses to this question and found the responses to be inappropriate. The CSRs would not provide us with the information we were seeking because we did not supply personal identifying information, such as the beneficiary’s Medicare number or date of birth. We considered such responses inappropriate because the CSRs could have answered this question without personal identifying information by using CMS’s Web-based prescription drug plan finder tool. Although CMS said that it has emphasized to CSRs, through training and broadcast messages, that it is permissible to provide the information we requested without requiring information that would personally identify a beneficiary, in these 35 instances, the CSR simply told us that our question could not be answered. CMS also said that the bulk of these inappropriate responses were related to our request that the CSR use only brand-name drugs. This is incorrect—none of these 35 responses were considered incorrect or inappropriate because of a request that the CSR use only brand-name drugs—as that was not part of our question. As arranged with your offices, unless you publicly announce the contents of this report earlier, we plan no further distribution of it until 30 days after its date. At that time, we will send copies of this report to the Secretary of Health and Human Services, the Administrator of the Centers for Medicare & Medicaid Services, and other interested parties. We will also make copies available to others on request. In addition, the report will be available at no charge on the GAO Web site at http://www.gao.gov. If you or your staff have any questions about this report, please contact me at (312) 220-7600 or aronovitzl@gao.gov. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this report. GAO staff who made major contributions to this report are listed in appendix IV. Medicare & You (Section 6: Medicare Prescription Drug Coverage) Dual-eligible beneficiaries are Medicare beneficiaries who receive full Medicaid benefits for services not covered by Medicare. Medicare Advantage replaces the Medicare+Choice managed care program and expands the availability of private health plan options to Medicare beneficiaries. Do You Have a Medigap Policywith Prescription Drug Coverage? sold by private insurers to help pay for Medicare cost- sharing requirements, as well as for some services not provided by Medicare. tested the usability of sample documents with 16 participants—11 Medicare beneficiaries, including 1 disabled beneficiary who was under 65, and 5 advisers to beneficiaries. Everyone was asked to perform 18 specified tasks related to enrollment, coverage, costs, penalty, and informational resources. They were also asked to provide feedback about their experiences. Although the size of the group was small, research shows that as few as 5 individuals can provide meaningful insights into common problems. consistency with laws, regulations, and CMS guidance. benefit are written at a reading level that is difficult for many seniors. Reading levels for the sample documents were challenging for at least the 40 percent of seniors, who read at or below the 5th grade level. Reading level estimates for the sample texts1 ranged from 7th grade to postcollege level. Reading levels remain challenging for at least 40 percent of seniors even after adjusting for 26 multisyllabic words, such as Medicare, Medicare Advantage, and Social Security Administration. After the adjustment, the estimated reading level ranged from 8th to 12th grade. Estimates have a likely margin of error of ± two grades. documents demonstrated adherence to about half of the 60 commonly recognized written communications guidelines, on average. Desirable features: The documents were written with a respectful and polite tone, were free of clichés and slang, contained useful contact information, included concise and descriptive headings, and generally followed graphic and formatting guidelines.