AMA outlines proposed fixes to Medicare Plan Finder

The Department of Health and Human Services' plan to update its Medicare Plan Finder tool is a step in the right direction, according to the American Medical Association.

The plan, recently announced by HHS, will ideally help consumers choose health insurance plans that will include the providers and hospitals they already visit, a key tenet to supporting a good patient experience, AMA said.

"When choosing their Medicare plan, patients need easy access to accurate, accessible and actionable information. Informed decision-makers have fewer regrets," AMA President Bobby Mukkamala, M.D., said in a statement. "We commend HHS' intent and commitments -- and see this as a clear response to persistent AMA advocacy on behalf of physicians and our patients."

The Medicare Plan Finder is a consumer-facing tool intended to help shoppers find the best Medicare plan for their healthcare needs. The system, which users can access via Medicare.gov, prompts shoppers to enter their zip code, medications and preferred pharmacies. In turn, the Medicare Plan Finder generates a list of plans that fit shopper criteria as well as plan costs.

In the past, the Medicare Plan Finder has been tricky for users to navigate, AMA explained, fueling some of the trade group's advocacy work. Particularly, AMA has called for a Medicare Plan Finder that lets users verify whether their provider will be in-network and filter plans by specialty and other factors such as language or location. Ideally, such a system would help consumers dodge post-enrollment surprises, AMA said.

As HHS considers an updated Medicare Plan Finder system, AMA suggested HHS adopt the following requirements of Medicare Advantage plans:

• Submit provider network updates within 30 days of any changes.
• Give HHS a contracted provider network list annually and whenever changes occur.
• Publish provider network lists on the Medicare Plan Finder website in a web-friendly and downloadable spreadsheet format.
• Attest to data accuracy via routine audits and fulfill meaningful penalties for bad or inaccurate data.
• Create automated data systems to avoid manual uploads of directory information.
• Connect Plan Finder to a national source of provider information to ensure there are no errors or duplicates.
• Build the consumer interface with health literacy considerations.

Ensuring the Medicare Plan Finder tool is usable and consumer-friendly will save providers and health plans administrative burden, AMA added.

"Physicians and patients will benefit if Plan Finder is user-friendly," Mukkamala explained. "Getting this right will reduce 'Are you in network?' calls, curtail avoidable plan switches, and spare front-desk staff the scavenger hunt across portals."

"We look forward to partnering with Secretary Kennedy to implement these practical updates quickly and keep them enforced over time," Mukkamala concluded. "Bottom line: HHS heard physicians. When HHS makes this happen, patients will finally be able to pick a plan with confidence that their care team is in network."

Sara Heath has reported news related to patient engagement and health equity since 2015.