-------------------------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 [email protected] or
(312) 220-7600.

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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