Is Medicare.gov Ever Wrong?

somarco

GA Medicare Expert
5000 Post Club
36,602
Atlanta
Working with a lady that takes a specific drug and can NOT take the generic. MUST be that specific drug.

I ran her list on Medicare.gov and it came back that Wellcare was the best choice.

All her meds covered on the formulary, no restrictions.

Sent her the printout comparing Wellcare to an AARP plan she had specifically asked about.

So ...............

She called Wellcare and they said "No, that drug is not on our formulary. You will have to pay full price".

So after she raked me over the coals about how bad the Medicare info was, she asked if there was a better plan than the AARP Saver.

Back to Medicare.gov I go and look for only AARP plans.

According to .gov the $45 AARP plan has her drug on tier 3 and a $40 copay, but the plan she picked (after talking with AARP before I was ever on the scene) is listed as tier 4 and costs $259 per month.

I use .gov all the time and have never known it to be off by this much which makes me wonder. Was .gov right when 2014 plans were first offered and Wellcare changed the formulary afterward, or was .gov always wrong?
 
I have filed a printout of the Plan Comparison for each client. If there is ultimately wrong info on .gov, then the client should qualify for this SEP...

"I joined a plan, or chose not to join a plan, due to an error by a federal employee."


Not that I have proved that data info on .gov would fall under this SEP, but it is what I am banking on if such an error weren't found until after the enrollment is complete.
 
I read somewhere that the plan is ultimately responsible for keeping their plan info on .gov accurate and are responsible to honor any mistakes.
 
Two responses, and thanks for that, but seems the both can be written up as definite maybe's.

At this point it seems like the disclaimers you see in public parking lots about how the owner of the establishment is not responsible for theft or damage.

It sure would be nice to know CMS can't hang my butt out to dry for an error on their site. I wonder if E&O covers this.

And like you, I also run a report and give it to each client showing the suggested plans, copay's, etc.
 
Two responses, and thanks for that, but seems the both can be written up as definite maybe's.

At this point it seems like the disclaimers you see in public parking lots about how the owner of the establishment is not responsible for theft or damage.

It sure would be nice to know CMS can't hang my butt out to dry for an error on their site. I wonder if E&O covers this.

And like you, I also run a report and give it to each client showing the suggested plans, copay's, etc.

To answer definitively, YES, .gov can and has been wrong in the past. As for whose responsibility it is, I can't say. But I would think someone at CMS is responsible for entering data into the system unless it's transferred to them electronically and migrated into the system. But either way, human error is a real possibility.
 
Formularies change all the time.

I try to remember to tell my clients that... and I DO tell them that .gov is subject to errors. Also, when inputting meds and dosages, I convert everything to monthly amounts, as that seems to reduce some of the errors.
 
The biggest problem I see when running prescriptions is there is a huge difference in the total price of the medication. This really alters the results when it's a drug that isn't covered or one that will put them in the doughnut hole quicker. Not unusual to see at least a $50 difference in price on a Humana plan vs. AARP plan for the same prescription. I just ran into this on a appt. last night.
 
I know that when you are selling Anthem's Med Advantage Plans it's required that you look all RX's up on Anthem's website not Medicare.gov.

If you get a complaint for wrong info on Medicare.gov, Anthem will toss you under the bus because they warn about that. It's much slower to update.
 
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