Page 11 - Delaware Department of Insurance

Educating, protecting and advocating for Medicare users
Commissioner Trinidad Navarro issued a rare consumer alert in
late November 2019 regarding Medicare’s newly updated Prescription Plan Finder. Throughout the regular open enrollment period, the Department of Insurance received numerous complaints about the tool and anticipated prescription drug costs.
The Prescription Plan Finder is used to identify and compare coverage options, however the tool focused on premium costs, which deflected focus from higher personal costs
at the pharmacy counter. The
tool organized responses to show lowest premium costs first, but not the lowest total annual costs, as was typical for previous iterations of the tool. Additionally, if a resident entered multiple medications, they may have received search results for plans that do not cover all of the prescriptions entered. The tool is used by more than 60 million seniors nationwide.
“Residents using this tool should
carefully consider costs in a holistic way to ensure they are getting
the best coverage and best price. The plan with the lowest premium may not always be the plan
with the lowest total costs,” said Commissioner Navarro. “If you, a family member, or a loved one are enrolled or enrolling in Medicare, I urge you to take your time on the tool and make sure all your plan questions are answered before making your final selections.”
In addition to educating residents about the issue to protect them from possible higher costs, the Department worked with members of the state congressional delegation to advocate for and discuss solutions that could be pursued at the federal level. Representative Lisa Blunt Rochester created a coalition of congressional representatives across the country and sent a formal letter to Centers of Medicare and Medicaid Services (CMS) about the issue, requesting
a special enrollment period
Residents using this tool should carefully consider costs in a holistic way to ensure they are getting the best coverage and best price.”
-Trinidad Navarro, Insurance Commissioner
for individuals who may have inadvertently selected a higher-cost plan unknowingly. CMS updated sorting options on the tool to better assist in cost-based decision- making, and made it known that Medicare users who encountered this issue can enter into special enrollment and update their plan choices at any time throughout
the year.
When asked about Department of Insurance services that Delaware residents often don’t know about, a top answer is arbitration services. This service allows all residents
to pursue solutions to insurance- related issues without requiring that they be able to afford
and obtain an attorney.
If complaints to the Insurance Commissioner’s Office about
an auto, homeowner or health insurance policy do not provide
a suitable solution to an issue, residents may take part in a formal process called “arbitration.”
In arbitration, you file a formal complaint against a company — somewhat like a lawsuit — but instead of a judge and jury, the
case is decided by independent experts. For cases involving home or auto insurance, the matter is decided by a three-person panel made up of an attorney and two insurance adjusters who have
no interest or stake in the case. For health insurance, it is a single expert.
Arbitration is available only after several attempts to resolve the matter informally have failed,
and will require a $50 filing fee
for home and auto cases or a
$75 filing fee for health insurance matters. Arbitration is not available to contest health insurance
policy denials based on medical necessity.
For example, if a resident is in a car
accident and his or her insurance company does not offer an acceptable sum, the department can help engage the insurance company in arbitration on the resident’s behalf to ensure they are given appropriate value
for the vehicle damage.
As of November 2019, the Department opened 455 arbitration cases, with settlements in 361 cases, with some overlap from the previous year. Residents have been awarded nearly $798,000 as a result of these processes in 2019 alone. Consumers won nearly 90% of the cases
heard throughout the year.
Learn more at insurance.delaware. gov/services/arbitration.
Arbitration services
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