Medicare Compliance & Reimbursement

More complaints about stand-alone PDPs than MA PDPs.

New statistics from the Centers for Medicare & Medicaid Services (CMS) reveal that the numbers of beneficiary complaints about Part D plans are "relatively low." And surprisingly, most of the complaints are not about customer service.

In June, CMS received approximately 2.3 complaints per 1,000 Medicare benes enrolled in a Part D prescription drug plan (PDP), according to sponsor-level data the agency posted on July 19. Stand-alone PDPs had average complaint rates of approximately 2.6 per 1,000 benes, and Medicare Advantage (MA) PDPs averaged approximately 1.4 per 1,000 benes, CMS says.

And CMS' statistics pinpointed the type of complaints most PDPs are encountering. "Most complaints are about enrollment or disenrollment in a plan, when beneficiaries start or stop using coverage, reflecting one-time issues in 'getting connected' to a plan," the agency notes. "A smaller share of complaints concern difficulties that beneficiaries have in getting needed drugs or plan customer service," CMS adds.

America's Health Insurance Plans' president and CEO Karen Ignagni is pleased with CMS' statistics, especially after the Government Accountability Office issued a recent report that accused Part D plans of providing poor customer service. CMS' report, however, "is in line with recent surveys that have found widespread enrollee satisfaction with the Medicare prescription drug benefit," she points out in a July 20 statement.

Many plans' complaint rates are less than 1 per-cent, CMS administrator Mark McClellan said in a July 19 statement.

But to keep these rates low--and to track plans with relatively high complaint rates--CMS is using these statistics and data "to address plans' weaknesses, to continue to find and fix problems and [to] drive for excellence in the service they are providing to their enrollees," he notes.

Plans with high complaint rates will not only receive extra scrutiny from CMS, but they will also be vulnerable to enforcement actions.
 
If CMS doesn't see improvement within a month of monitoring the plan's complaint rates, the agency could restrict the plan's ability to enroll benes or impose fines, CMS warns.

To view the complaint-rate statistics for MA PDPs, go to www.cms.hhs.gov/apps/files/Press1905_JunePartDMAPDRates_060719.pdf.

To see stand-alone PDPs' complaint rates, go to www.cms.hhs.gov/apps/files/Press1905_JunePartDPDPComplaintRates_060719.pdf.