    -------------------------Indexing Terms-------------------------
    REPORTNUM:   GAO-06-715T

    TITLE:     Medicare: Quality of CMS Communications to Beneficiaries
    on the Prescription Drug Benefit Could Be Improved

    DATE:   05/04/2006

    -----------------------------------------------------------------

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    GAO-06-715T

         * Background
         * Clarity of CMS Written Documents Could Be Improved
         * Help Line Responses Frequently Complete and Accurate, but Va
         * Part D Benefit Portion of Medicare Web Site Can Be Challengi
         * Concluding Observations
         * Contact and Acknowledgments
         * GAO's Mission
         * Obtaining Copies of GAO Reports and Testimony
              * Order by Mail or Phone
         * To Report Fraud, Waste, and Abuse in Federal Programs
         * Congressional Relations
         * Public Affairs

    Testimony

    Before the Subcommittee on Health, Committee on Ways and Means, House of
    Representatives

    United States Government Accountability Office

    GAO

    For Release on Delivery Expected at 2:00 p.m. EDT

    Thursday, May 4, 2006

    MEDICARE

    Quality of CMS Communications to Beneficiaries on the Prescription Drug
    Benefit Could Be Improved

    Statement of Leslie G. Aronovitz

    Director, Health Care

    GAO-06-715T

    Mr. Chairman and Members of the Subcommittee:

    I am pleased to be here today as you discuss the Medicare outpatient
    prescription drug benefit, known as the Part D benefit, which was
    established by the Medicare Prescription Drug, Improvement, and
    Modernization Act of 20031 with coverage beginning on January 1, 2006.
    Until this time, Medicare, the program that finances health care benefits
    for about 42 million elderly and disabled beneficiaries, had not generally
    provided coverage for outpatient prescription drugs. Beneficiaries who opt
    to enroll in Part D may choose a drug plan from those offered by private
    plan sponsors under contract to the Centers for Medicare & Medicaid
    Services (CMS), which administers the Part D benefit. These plans differ
    in the drugs covered, pharmacies used, and enrollee costs. As of April 20,
    2006, more than 30 million of Medicare's 42 million beneficiaries were
    enrolled in a Part D plan or had other outpatient prescription drug
    coverage. Beneficiaries have until the end of the current enrollment
    period, May 15, 2006, to enroll in the Part D benefit and select a plan
    without the risk of penalties in the form of higher premiums.

    Given the newness and complexity of the Part D benefit, it is critical
    that beneficiaries and their advisers, including members of their
    families, understand the options available to them. Understanding these
    options enables beneficiaries to make informed decisions on whether to
    enroll in the Part D benefit, and if they decide to enroll, which drug
    plan to choose. As part of its responsibilities, CMS has undertaken
    efforts to provide beneficiaries and their advisers with the information
    they need about the Part D benefit through various media, including
    written documents, the 1-800-MEDICARE help line,2 and the Medicare Web
    site.3 CMS's education efforts are important because widespread confusion
    has been reported among beneficiaries about the costs and coverage under
    the new benefit.

    1Pub. L. No. 108-173, S: 101, 117 Stat. 2066, 2071-2152 (to be codified at
    42 U.S.C. S:S: 1395w-101-1395w-152). The MMA redesignated the previous
    part D of title XVIII of the Social Security Act as part E and inserted a
    new part D after part C.

    2In December 2004, we reported on the information being provided to
    beneficiaries through the Medicare help line on eligibility, enrollment,
    and benefits. See GAO, Medicare: Accuracy of Responses from the
    1-800-MEDICARE Help Line Should Be Improved, GAO-05-130 (Washington, D.C.:
    Dec. 8, 2004).

    3The Medicare Web site is www.medicare.gov.

    You and others have expressed interest in ensuring that Medicare
    beneficiaries receive the information they need to make informed
    decisions. My remarks today will focus on (1) the extent to which CMS's
    written documents describe the Part D benefit in a clear, complete, and
    accurate manner; (2) the effectiveness of CMS's 1-800-MEDICARE help line
    in providing accurate, complete, and prompt responses to callers inquiring
    about the Part D benefit; and (3) whether CMS's Medicare Web site presents
    information on the Part D benefit in a usable manner. My testimony will
    summarize findings of a report we released yesterday that examines CMS's
    Medicare Part D benefit communications to beneficiaries in more detail and
    includes recommendations to the CMS Administrator for improving the
    quality of the agency's Part D benefit education and outreach materials.4

    To address these issues, we interviewed CMS officials responsible for
    written documents about the Part D benefit, the 1-800-MEDICARE help line,
    and the Medicare Web site. To assess the clarity, completeness, and
    accuracy of written documents, we performed an in-depth review of a sample
    of six CMS documents describing the Part D benefit, including contracting
    with the American Institutes for Research (AIR), a firm with experience in
    evaluating written documents, to assess their clarity. (See app. I for a
    list of written documents reviewed.) We also placed 500 calls to
    1-800-MEDICARE, posing one of five questions related to the Part D benefit
    in each call so that each question was asked 100 times. We evaluated the
    accuracy and completeness of customer service representatives' (CSR)
    responses to these questions. (See app. II for the questions and criteria
    we used to evaluate the accuracy and completeness of CSR responses to
    calls we made to 1-800 MEDICARE.) To assess the usability of the Part D
    benefit information available on the Medicare Web site, we contracted with
    the Nielsen Norman Group (NN/g), an expert on Web design. We conducted our
    work from November 2005 through May 2006, in accordance with generally
    accepted government auditing standards.

    In summary, CMS successfully developed a large volume of information about
    the new Part D benefit and made it available to beneficiaries through a
    variety of sources, despite the challenge of developing this information
    within a short time frame. However, the quality of CMS's communications to
    beneficiaries and their advisers about the Part D benefit could be
    improved. For example, although the six CMS written documents we reviewed
    were largely accurate and complete, they often lacked clarity.
    Specifically, while about 40 percent of seniors read at or below the
    fifth-grade level, the reading levels of the documents ranged from seventh
    grade to postcollege. Moreover, the six documents used too much technical
    jargon and often did not define difficult terms. Similarly, although 67
    percent of the responses to the 500 calls we placed to CMS's
    1-800-MEDICARE help line regarding the Part D benefit were accurate and
    complete, we nonetheless received a substantial number of responses that
    were not. Eighteen percent of the calls received inaccurate responses, 8
    percent of the responses were inappropriate given the question asked,
    about 3 percent received incomplete responses, and about 5 percent of our
    calls were not answered, primarily due to disconnections.5 In addition,
    our review of the Part D benefit portion of the Medicare Web site showed
    that this site can be difficult to use. In usability tests that examined
    the ease of finding needed information and performing various tasks, we
    found that, for overall usability, the Web site scored 47 percent for
    seniors and 53 percent for younger adults, out of a possible 100 percent.
    While there is no widely accepted benchmark for usability, these scores
    indicate that using the site can be difficult. Therefore, in the report we
    issued yesterday, we made specific recommendations to the CMS
    Administrator to enhance the quality of the agency's communications on the
    Part D benefit, including clarifying written materials, monitoring the
    accuracy and completeness of CSR's responses to callers' inquiries, and
    improving the usability of the Part D benefit portion of the Medicare Web
    site. In its comments on a draft of our report (see app. III), CMS said
    that it supports the goals of our recommendations and is already taking
    steps to implement them. However, CMS said that our findings did not
    present a complete and accurate picture of its Part D benefit
    communications activities. We believe that our report provides an accurate
    examination of the CMS communications mechanisms that have the greatest
    impact on beneficiaries (see app. IV).

    4GAO, Medicare: Communications to Beneficiaries on the Prescription Drug
    Benefit Could Be Improved, GAO-06-654 (Washington, D.C.: May 3, 2006).

    5The percentages related to the responses we received to our 500 calls
    exceed 100 percent due to rounding.

                                       Background

    CMS has undertaken steps to educate beneficiaries about the Part D benefit
    using written documents, a toll-free help line, and the Medicare Web site.
    To explain the Part D benefit to beneficiaries, CMS had produced more than
    70 written documents as of December 2005. Medicare & You-the beneficiary
    handbook-is the most widely available and was sent directly to
    beneficiaries in October 2005. Other written documents were targeted to
    specific groups of beneficiaries, such as dual-eligible beneficiaries6 and
    beneficiaries with Medicare Advantage or Medigap policies.7

    Beneficiaries can obtain answers to questions about the Part D benefit by
    calling the 1-800-MEDICARE help line. This help line, which is
    administered by CMS, was established in March 1999, to answer
    beneficiaries' questions about the Medicare program. As of December 2005,
    about 7,500 CSRs were handling calls on the help line, which operates 24
    hours a day, 7 days a week, and is run by two CMS contractors. CMS
    provides CSRs with detailed scripts to use in answering the questions.
    Call center contractors write the scripts, and CMS checks them for
    accuracy and completeness.

    In addition, CMS's Medicare Web site provides information about various
    aspects of the Medicare program. The Web site contains basic information
    about the Part D benefit, suggests factors for beneficiaries to consider
    when choosing plans and provides guidance on enrollment and plan
    selection. It also lists frequently asked questions, and allows users to
    view, print, or order publications. In addition, the site contains
    information on cost and coverage of individual plans. There is also a tool
    that allows beneficiaries to enroll directly in the plan they have chosen.

    6Dual-eligible beneficiaries are Medicare beneficiaries who are also
    eligible for Medicaid-the federal-state health program for low-income
    individuals-and receive full Medicaid benefits for services not covered by
    Medicare.

    7Medicare Advantage replaced the Medicare+Choice managed care program and
    expanded the availability of private health plan options to Medicare
    beneficiaries. Medigap policies provide supplemental health coverage sold
    by private insurers to help pay for Medicare cost-sharing requirements, as
    well as for some services not provided by Medicare.

                   Clarity of CMS Written Documents Could Be Improved

    Although the six sample documents we reviewed informed readers of
    enrollment steps and factors affecting coverage, they lacked clarity in
    two ways. First, about 40 percent of seniors read at or below the
    fifth-grade level, but the reading levels of the documents ranged from
    seventh grade to postcollege. As a result, these documents are challenging
    for many seniors. Even after adjusting the text for 26 multisyllabic
    words, such as Medicare, Medicare Advantage, and Social Security
    Administration, the estimated reading level ranged from seventh to twelfth
    grade, a reading level that would remain challenging for at least 40
    percent of seniors.

    Second, on average, the six documents we reviewed did not comply with
    about half of the 60 commonly recognized guidelines for good
    communications. For example, although the documents included concise and
    descriptive headings, they used too much technical jargon and often did
    not define difficult terms such as formulary.8 The 11 beneficiaries and 5
    advisers we tested reported frustration with the documents' lack of
    clarity as they encountered difficulties in understanding and attempting
    to complete 18 specified tasks. For example, none of these beneficiaries
    and only 2 of the advisers were able to complete the task of computing
    their projected total out-of-pocket costs for a plan that provided Part D
    standard coverage. Only one of 18 specified tasks was completed by all
    beneficiaries and advisers. Even those who were able to complete a given
    task expressed confusion as they worked to comprehend the relevant text.

      Help Line Responses Frequently Complete and Accurate, but Varied By Question

    Of the 500 calls we placed to CMS's 1-800-MEDICARE help line regarding the
    Part D benefit, CSRs answered about 67 percent of the calls accurately and
    completely. Of the remainder, 18 percent of the calls received inaccurate
    responses, 8 percent of the responses were inappropriate given the
    question asked, and about 3 percent received incomplete responses. In
    addition, about 5 percent of our calls were not answered, primarily
    because of disconnections.9

    The accuracy and completeness of CSR responses varied significantly across
    our five questions. (See fig. 1.) For example, while CSRs provided
    accurate and complete responses to calls about beneficiaries' eligibility
    for financial assistance 90 percent of the time, the accuracy rate for
    calls concerning the drug plan that would cost the least for a beneficiary
    with specified prescription drug needs was 41 percent. CSRs
    inappropriately responded 35 percent of the time that this question could
    not be answered without personal identifying information-such as the
    beneficiary's Medicare number or date of birth-even though the CSRs could
    have answered our question using CMS's Web-based prescription drug plan
    finder tool. CSRs' failure to read the correct script also contributed to
    inaccurate responses. The time GAO callers waited to speak with CSRs also
    varied, ranging from no wait time to over 55 minutes. For 75 percent of
    the calls-374 of the 500-the wait was less than 5 minutes.

    8A formulary is a list of prescription drugs covered by a health plan.

    9The percentages related to the responses we received to our 500 calls
    exceed 100 percent because of rounding.

    Figure 1: Variation in CSRs' Responses for Individual Questions

         Part D Benefit Portion of Medicare Web Site Can Be Challenging to Use

    We found that the Part D benefit portion of the Medicare Web site can be
    difficult to use. In our evaluation of overall usability-the ease of
    finding needed information and performing various tasks-we found usability
    scores of 47 percent for seniors and 53 percent for younger adults, out of
    a possible 100 percent. While there is no widely accepted benchmark for
    usability, these scores indicate difficulties in using the site. For
    example, tools such as the drug plan finder were complicated to use, and
    forms that collect information on-line from users were difficult to
    correct if the user made an error.

    We also evaluated the usability of 137 detailed aspects of the Part D
    benefit portion of the site, including features of Web design and on-line
    tools, and found that 70 percent of these aspects could be expected to
    cause users confusion. For example, key functions of the prescription drug
    plan finder tool, such as the "continue" and "choose a drug plan" buttons,
    were often not visible on the page without scrolling down. In addition,
    the drug plan finder tool defaults-or is automatically reset-to generic
    drugs, which may complicate users' search for drug plans covering brand
    name drugs. The material in this portion of the Web site is written at the
    11th grade level, which can also present challenges to some users.
    Finally, in our evaluation of the ability of seven participants to
    collectively complete 34 user tests, we found that on average,
    participants were only able to proceed slightly more than half way though
    each test. When asked about their experiences with using the Web site, the
    seven participants, on average, indicated high levels of frustration and
    low levels of satisfaction.

                                Concluding Observations

    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 the
    Part D benefit. To disseminate these materials, CMS largely added
    information to existing resources, including written documents, such as
    Medicare & You; the 1-800-MEDICARE help line; and the Medicare Web site.
    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. Although the initial enrollment period for
    the Part D benefit will end on May 15, 2006, CMS will continue to play a
    pivotal role in providing beneficiaries with information about the drug
    benefit in the future. The recommendations we have made would help CMS to
    ensure that beneficiaries and their advisers are prepared when deciding
    whether to enroll in the benefit, and if enrolling, which drug plan to
    choose.

    Mr. Chairman, this concludes my prepared remarks. I would be happy to
    respond to any questions that you or other Members of the subcommittee may
    have at this time.

                              Contact and Acknowledgments

    For further information regarding this statement, please contact Leslie G.
    Aronovitz at (312) 220-7600. Contact points for our Offices of
    Congressional Relations and Public Affairs may be found in the last page
    of this statement. Susan T. Anthony and Geraldine Redican-Bigott,
    Assistant Directors; Shaunessye D. Curry; Helen T. Desaulniers; Margaret
    J. Weber; and Craig H. Winslow made key contributions to this statement.

    Appendix I: Sample of CMS Written Documents Reviewed

    To assess the clarity, completeness, and accuracy of written documents, we
    compiled a list of all available CMS-issued Part D benefit publications
    intended to inform beneficiaries and their advisers and selected a sample
    of 6 from the 70 CMS documents available, as of December 7, 2005, for
    in-depth review, as shown in Table 1. The sample documents were chosen to
    represent a variety of publication types, such as frequently asked
    questions and fact sheets available to beneficiaries about the Part D
    benefit. We selected documents that targeted all beneficiaries or those
    with unique drug coverage concerns, such as dual-eligibles and
    beneficiaries with Medigap plans.

    Table 1: Sample of Six Selected Documents

    Document                                      Target audience
    Medicare & You, Section 6: Medicare           All beneficiaries
    Prescription Drug Coverage
    Things to Think about When You Compare Plans  All beneficiaries
    Frequently Asked Questions about: Retiree     Beneficiaries with employer
    Prescription Drug Coverage & the New Medicare or union coverage
    Prescription Drug Coverage
    Introduction to the Auto-Enrollment Notice    Dual-eligible beneficiariesa
    Quick Facts about Medicare's New Coverage for Beneficiaries with Medicare
    Prescription Drugs for People with a Medicare Advantageb
    Health Plan with Prescription Drug Coverage
    Do You Have a Medigap Policy with             Beneficiaries with Medigapc
    Prescription Drug Coverage?

    Source: GAO.

    aDual-eligible beneficiaries are Medicare beneficiaries who receive full
    Medicaid benefits for services not covered by Medicare.

    bMedicare Advantage replaced the Medicare + Choice managed care program
    and expanded the availability of private health plan options to Medicare
    beneficiaries.

    cMedigap policies provide supplemental health coverage sold by private
    insurers to help pay for Medicare cost-sharing requirements, as well as
    for some services not provided by Medicare.

    Appendix III: Comments from the Centers for Medicare & Medicaid's Services
    Appendix II: Questions and Criteria Used to Evaluate Accuracy and
    Completeness of CSR's Help Line Responses

    To determine the accuracy and completeness of information provided
    regarding the Part D benefit, we placed a total of 500 calls to the
    1-800-MEDICARE help line. We posed one of five questions about the Part D
    benefit in each call, so that each question was asked 100 times. Table 2
    summarizes the questions we asked and the criteria we used to evaluate the
    accuracy of responses.

    Table 2: Questions and Criteria Used to Evaluate Accuracy and Completeness

    Question GAO Asked MEDICARE help Criteria GAO used to evaluate accuracy
    line CSRs                        and completeness of CSR Responses
          1. What drug plan can a       An accurate and complete response would
          beneficiary get that will     identify the prescription drug plan that
          cover all of his/her          has the lowest estimated annual cost for
          [specified] drugs at a        the drugs the beneficiary uses.
          [specified] pharmacy, have a
          mail-order option; and cost
          the least amount annually
          with [or without] a
          deductible?
          2. Can a beneficiary who is   An accurate and complete response would
          in a nursing home and not on  indicate that a beneficiary can choose
          Medicaid sign up for a        whether to enroll in a Medicare
          prescription drug plan?       prescription drug plan.
          3. Can a beneficiary enroll   An accurate and complete response would
          in the Medicare prescription  inform the caller that enrolling for the
          drug program and keep his/her prescription drug benefit would depend on
          current Medigap policy?       whether the beneficiary's Medigap plan
                                        was creditable-that is, whether the
                                        coverage it provided was at least as good
                                        as Medicare's standard prescription drug
                                        coverage-or noncreditable. The CSR
                                        response would also mention that the
                                        beneficiary's Medigap plan should have
                                        sent him/her information that outlined
                                        options.
          4. What options does a        An accurate and complete response would
          beneficiary, who has retiree  indicate that a beneficiary has two
          health insurance with         options: (1) keep current health plan and
          prescription drug coverage    join the prescription drug plan later
          that is not as good as the    with a penalty, or (2) drop current
          Medicare prescription drug    coverage and join a Medicare drug plan.
          coverage, have as it relates
          to the Medicare benefit?
          5. How do I know if a         An accurate and complete response would
          beneficiary qualifies for     refer the beneficiary to the Social
          financial assistance?         Security Administration.

    Source: GAO.

    Appendix III: Comments from the Centers for Medicare & Medicaid's Services
    Appendix III: Comments from the Centers for Medicare & Medicaid's Services

    Appendix IV: Agency Comments and Our Evaluation Appendix IV: Agency
    Comments and Our Evaluation

    We received written comments on a draft of our 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 our 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.

    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.

    (290546)

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    www.gao.gov/cgi-bin/getrpt? GAO-06-715T .

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    For more information, contact Leslie G. Aronovitz at aronovitzl@gao.gov or
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    Highlights of GAO-06-715T , a testimony before the Subcommittee on Health,
    Committee on Ways and Means, U.S. House of Representatives

    May 4, 2004

    MEDICARE

    Quality of CMS Communications to Beneficiaries on the Prescription Drug
    Benefit Could Be Improved

    Today's hearing focuses on Medicare Part D, the program's new outpatient
    prescription drug benefit. On January 1, 2006, Medicare began providing
    this benefit, and beneficiaries have until May 15, 2006, to enroll without
    the risk of penalties. The Centers for Medicare & Medicaid Services (CMS),
    which administers the Part D benefit, has undertaken outreach and
    education efforts to inform beneficiaries and their advisers.

    GAO was asked to discuss how CMS can better ensure that Medicare
    beneficiaries are informed about the Part D benefit. This testimony is
    based on Medicare:  Communications to Beneficiaries on the Prescription
    Drug Benefit Could Be Improved, GAO-06-654 (May 3, 2006).

    What GAO Recommends

    In its May 2006 report, GAO recommended that the CMS Administrator enhance
    the quality of its communications on the Part D benefit, including
    clarifying written materials, monitoring the accuracy and completeness of
    help line responses, and improving the usability of the Medicare Web site.
    CMS said that GAO's findings did not present a complete and accurate
    picture of its activities. However, CMS said that it supports the goals of
    GAO's recommendations and is already taking steps to implement them.

    Information given in the six sample documents that GAO reviewed describing
    the Part D benefit was largely complete and accurate, although this
    information lacked clarity. First, about 40 percent of seniors read at or
    below the fifth-grade level, but the reading levels of these documents
    ranged from seventh grade to postcollege. Second, on average, the six
    documents we reviewed did not comply with about half of 60 common
    guidelines for good communication. For example, the documents used too
    much technical jargon and often did not define difficult terms. Moreover,
    16 beneficiaries and advisers that GAO tested reported frustration with
    the documents' lack of clarity and had difficulty completing the tasks
    assigned to them.

    Customer service representatives (CSRs) answered about two-thirds of the
    500 calls GAO placed to CMS's 1-800-MEDICARE help line accurately and
    completely. Of the remainder, 18 percent of the calls received inaccurate
    responses, 8 percent of the responses were inappropriate given the
    question asked, and about 3 percent received incomplete responses. In
    addition, about 5 percent of GAO's calls were not answered, primarily
    because of disconnections. The accuracy and completeness of CSRs'
    responses varied significantly across the five questions. For example,
    while CSRs provided accurate and complete responses to calls about
    beneficiaries' eligibility for financial assistance 90 percent of the
    time, the accuracy rate for calls concerning the drug plan that would cost
    the least for a beneficiary with specified prescription drug needs was 41
    percent. For this question, the CSRs responded inappropriately for 35
    percent of the calls by explaining that they could not identify the least
    costly plan without the beneficiary's personal information-even though
    CSRs had the information needed to answer the question. The time GAO
    callers waited to speak with CSRs also varied, ranging from no wait time
    to over 55 minutes. For 75 percent of the calls-374 of the 500-the wait
    was less than 5 minutes.

    The Part D benefit portion of the Medicare Web site can be difficult to
    use. GAO's test of the site's overall usability-the ease of finding needed
    information and performing various tasks-resulted in scores of 47 percent
    for seniors and 53 percent for younger adults, out of a possible 100
    percent. While there is no widely accepted benchmark for usability, these
    scores indicate that using the site can be difficult. For example, the
    prescription drug plan finder was complicated to use and some of its key
    functions, such as "continue" and "choose a drug plan," were often not
    visible on the page without scrolling down.
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