Draft Guide to Medicare Benefits Called Confusing

A government guide designed to educate Medicare recipients about their benefits is getting a rewrite after many statements were determined to be incorrect, misleading or confusing.

A preliminary draft of the 2006 Medicare handbook will be reworked after members of Congress, insurers, state insurance regulators and advocates for beneficiaries criticized the handbook, the New York Times reported.

One major problem is the new prescription drug benefit – which will be confusing under the best of circumstances because it is new – is not fully explained. The guide does not describe the gap in coverage that beneficiaries will face after paying a $250 deductible. At that point, Medicare pays 75 percent of the next $2,250 in drug costs, but nothing between that figure and $5,100 - a gap in coverage of $2,850.

Also, the 106-page handbook mixes together the well-known, government-run Medicare program, which covers 36 million people, and Medicare programs administered through private health maintenance organizations and preferred provider organizations, in which fewer than 100,000 have enrolled, the Times reported.

Vicki Gottlich, a lawyer at the Center for Medicare Advocacy, a nonprofit group that counsels beneficiaries, told the newspaper that it was "inaccurate and misleading" to emphasize the similarities between the two plans, which in fact are quite different.

Advocates for older Americans are urging simplicity in the Medicare program. The AARP, for example, said that new research shows “too many options can produce paralysis.” Also, the Kaiser Family Foundation found in an April poll that two-thirds of Americans 65 and older said they did not understand the new drug benefit, which becomes available Jan. 1.

The foundation, in its Kaiser Daily Health Policy Report, said that other critics have said the ”Medicare & You” guidebook contains unfamiliar terminology, such as "creditable coverage"; misleading information about switching health plans; and uses income figures that differ from those used by the Social Security Administration.

The Centers for Medicare and Medicaid Services will revise the handbook, which will be sent to all Medicare beneficiaries in the fall after it is corrected, said spokesman Gary R. Karr. "It's a real challenge to describe things accurately and completely while not giving so much detail that you overload and confuse the beneficiaries," he said. “It's a balancing act. The handbook is taken very seriously by beneficiaries. We've got to make sure we get it right."

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