United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1998-05-06 monographic deposited born digital 16 p. GA 1.13:T-HEHS-98-162 https://www.govinfo.gov/app/details/GAOREPORTS-T-HEHS-98-162 P0b002ee1803a04ef f:he98162t DGPO 2010-08-12 2011-03-28 GAOREPORTS-T-HEHS-98-162 machine generated eng fdlp REPORT GAOREPORTS-T-HEHS-98-162 T-HEHS-98-162 Health care programs Health maintenance organizations Health services administration Marketing Beneficiaries Information disclosure Comparative analysis Medicare Choice Program Medicare Program Federal Employees Health Benefits Program HCFA Consumer Assessments of Health Plans Study Testimony HEHS Pursuant to a congressional request, GAO discussed the extent to which the Health Care Financing Administration's (HCFA) Medicare Choice information development efforts are likely to: (1) enable beneficiaries to readily compare benefits and out-of-pocket costs using plan brochures; and (2) facilitate the agency's approval of plans' marketing materials and other administrative work required of both HCFA and the health plans.<p/>GAO noted that: (1) HCFA has begun making certain plan-specific information available to beneficiaries; (2) these efforts, however, do not address the problem beneficiaries face in trying to carefully evaluate their health plan choices using the plans' summaries of benefits and other marketing materials; (3) these materials are a major source of health plan information; (4) currently, plans use widely varied formats and definitions of benefits in the materials they distribute to beneficiaries; (5) this lack of common formatting and language made it difficult, if not impossible, for beneficiaries to rely on HMOs' marketing literature to compare benefits and premiums; (6) preliminary results from GAO's current work on HMOs' prescription drug benefit suggest this situation continues to exist; (7) GAO's current work also suggests that critical information is sometimes missing from plans' marketing materials; (8) the diverse formats and terms also cause problems for health plans and HCFA staff; (9) without HCFA's specifying common standards for plans' marketing materials, agency staff have wide discretion when deciding to approve or reject these documents; (10) plan representatives and HCFA staff stated that this latitude leads to inconsistent HCFA decisions, unnecessary delays, and extra costs; (11) the lack of required standards similarly affects the efficient development of comparative benefits information; (12) to help beneficiaries evaluate their health plan options, HCFA could move faster to publish readily available plan performance indicators such as plans' disenrollment rates; (13) with this information, beneficiaries could then decide to seek more information about a plan before enrolling; (14) HCFA could better serve beneficiaries, reduce burdens on health plans, and leverage its own resources by setting information standards for health plans' marketing literature; (15) GAO believes, therefore, that HCFA should adopt the recommendations it made in 1996 and require plans to use standard formats and terminology in their benefit descriptions; and (16) in addition, HCFA should use plan performance data it already collects to help inform beneficiaries' health plan decisions. https://www.govinfo.gov/content/pkg/GAOREPORTS-T-HEHS-98-162/html/GAOREPORTS-T-HEHS-98-162.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-T-HEHS-98-162/pdf/GAOREPORTS-T-HEHS-98-162.pdf GAO/T-HEHS-98-162 https://www.govinfo.gov/app/details/GAOREPORTS-T-HEHS-98-162 Testimony GAO/T-HEHS-98-162; Medicare Managed Care: Information Standards Would Help Beneficiaries Make More Informed Health Plan Choices; Health care programs Health maintenance organizations Health services administration Marketing Beneficiaries Information disclosure Comparative analysis Medicare Choice Program Medicare Program Federal Employees Health Benefits Program HCFA Consumer Assessments of Health Plans Study Public Law 105-33