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 1999-04-13 monographic deposited born digital 20 p. GA 1.13:T-HEHS-99-108 https://www.govinfo.gov/app/details/GAOREPORTS-T-HEHS-99-108 P0b002ee18039bb1b f:he99108t DGPO 2010-08-12 2011-03-24 GAOREPORTS-T-HEHS-99-108 machine generated eng fdlp REPORT GAOREPORTS-T-HEHS-99-108 T-HEHS-99-108 Comparative analysis Health insurance Marketing Consumer protection Information disclosure Health services administration Beneficiaries Dispute settlement Managed health care Standards and standardization Federal Employees Health Benefits Program Medicare Program Medicare Choice Program Testimony HEHS Pursuant to a congressional request, GAO discussed the: (1) accuracy, completeness, and usefulness of the information Medicare managed care organizations (MCO) distribute about their plans' benefit packages; (2) extent to which MCOs inform beneficiaries of their plan appeal rights and the appeals process; and (3) Health Care Financing Administration's (HCFA) review, approval, and oversight of the plan information that MCOs distribute.<p/>GAO noted that: (1) it found problems with the benefit information distributed by all of the 16 MCOs it reviewed; (2) although HCFA had reviewed and approved all of the information GAO examined, some MCOs misstated the coverage they were required by Medicare or their contracts to offer; (3) one MCO advertised a substantially less generous prescription drug benefit than it had specified in its Medicare contract; (4) some MCOs provided complete benefit information only after a beneficiary enrolled; (5) others never provided full descriptions of benefits and restrictions; (6) as GAO has reported previously, it is difficult to compare available options using literature provided to beneficiaries because MCOs use different formats and terminology to describe the benefit packages being offered; (7) the variation in Medicare plan literature contrasts sharply with the uniformity of plan information distributed by MCOs that participate in the Federal Employees Health Benefits Program (FEHBP); (8) MCOs participating in FEHBP are required to provide prospective enrollees with a single, comprehensive, and comparable brochure to facilitate informed choice; (9) in GAO's study of the appeals process, GAO found that when MCOs deny plan services or payment, they do not always inform beneficiaries of their appeal rights; (10) sometimes MCOs issue denial notices that do not contain all the information that HCFA requires; (11) GAO also found that some MCOs delay issuing denial notices until the day before discontinuing services, such as skilled nursing care; (12) this delay can increase a beneficiary's potential financial liability should the beneficiary appeal the plan's decision and lose; (13) many of the information problems GAO identified regarding plan benefit packages and beneficiaries' appeal rights went uncorrected because of shortcomings in HCFA's review practices; (14) in addition, HCFA has not exercised its authority to require MCOs to distribute plan information that is more complete, timely, and comparable; (15) agency officials recognize many of the shortcomings GAO identified and are beginning efforts to address them; and (16) however, GAO believes that the agency could do more. https://www.govinfo.gov/content/pkg/GAOREPORTS-T-HEHS-99-108/html/GAOREPORTS-T-HEHS-99-108.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-T-HEHS-99-108/pdf/GAOREPORTS-T-HEHS-99-108.pdf GAO/T-HEHS-99-108 https://www.govinfo.gov/app/details/GAOREPORTS-T-HEHS-99-108 Testimony GAO/T-HEHS-99-108; Medicare Plus Choice: HCFA Actions Could Improve Plan Benefit and Appeal Information; Comparative analysis Health insurance Marketing Consumer protection Information disclosure Health services administration Beneficiaries Dispute settlement Managed health care Standards and standardization Federal Employees Health Benefits Program Medicare Program Medicare Choice Program