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--- Begin Message ---Asclepios Your Weekly Medicare Consumer Advocacy Update Protecting Consumers February 14, 2008, Volume 8, Issue 7 We know what works. Legislation passed in 1990 regulating Medigap plans--insurance that covers the cost sharing under Original Medicare--largely ended the rampant marketing abuse that had subjected older adults to high-pressure, deceptive sales tactics and saddled many with multiple plans offering duplicative or substandard coverage. That legislation should serve as a model for ending the abuses that have characterized the market for Medicare private health plans--so-called Medicare Advantage plans. Key elements of the Medigap model are increasingly recognized as applicable to the market for Medicare private health plans. In testimony before the Senate Finance Committee last week, the vice president of sales for Humana, the Kentucky-based health insurance giant, recommended regulating the commissions paid to agents selling Medicare health plans. Such regulation already exists for sellers of Medigap plans and works well in discouraging agents from "churning"--moving customers unnecessarily to new coverage in order to win a commission. Leveling commissions would help preserve continuity of coverage in Medicare private health plans, without which any hope of providing coordinated care is illusory. It would also eliminate the volume bonuses--including those promoted by Humana--that encourage agents to sign up people with Medicare without regard to whether the plan suits their needs. The Humana executive also proposed more stringent standards against "cross-selling"--using the opening provided from pitching a Medicare product to sell non-health insurance. The Centers for Medicare & Medicaid Services (CMS) goes even further, proposing in the draft contract terms for Medicare Advantage plans that agents be prohibited from using an in-home appointment scheduled for one product--a Medigap or prescription drug plan, for example--to enroll someone in a Medicare Advantage plans. Instead, the agent would have to wait 48 hours before returning to pitch the Medicare Advantage plan, giving the consumer time to review the benefits and drawbacks of the plan and consult with caregivers or independent counselors. These sensible rules would prevent agents from using one product to get their foot in the door and then using hard-sell tactics to sell coverage a consumer does not want. Cross-selling prohibitions are also long-standing practices among state insurance commissioners. But new rules alone won't do the job. CMS does not have the experience or personnel to see to it that agents and plans abide by those rules. State insurance departments have the know-how and the people, but they are preempted by law from taking any enforcement action against the plans. That is simply unworkable. What we need is simple: *Rules that eliminate or at least reduce the incentive and opportunities for abusive, fraudulent and deceptive marketing of Medicare private health plans *Enough cops on the beat to enforce those rules * * * * Medical Record "...[T]he current regulatory bifurcation (i.e., CMS has exclusive regulatory jurisdiction over the companies and states have jurisdiction over agents) creates a wide regulatory gap that invites exploitation by both companies and agents. When state regulators attempt to protect consumers, the companies cite preemption and advise regulators that CMS limits jurisdiction. This gap harms consumers" (Testimony of Michael McRaith, Director of the Illinois Division of Insurance, Before the U.S. Senate Finance Committee (http://www.kintera.org/TR.asp?a=bpIOK1NzGaIJL5K&s=svK7KiORLdK0JdM0G&m=mlKXJdOVJeL4H), February 7, 2008). "The Secretary of HHS should establish a requirement that limits the total commission compensation paid to agents to a fixed percentage of premium. This will ensure agents fully inform beneficiaries of the products and associated plan rules and will reduce the opportunity for high-pressure sales. Further, such requirements should provide for level commission payments year-over-year--for renewal sales as well as for replacement sales" (Testimony by Patrick O'Toole, Vice President of Medicare Sales, Humana, Inc., Before the U.S. Senate Finance Committee (http://www.kintera.org/TR.asp?a=eiJUKaOLIdLQJfJ&s=svK7KiORLdK0JdM0G&m=mlKXJdOVJeL4H), February 7, 2008). "These people were operating under false pretenses that they represent Medicare. I know of one other person that is going through this same thing with these same people. We just want to be heard and live accordingly. Don't bury us before we die. It seems like the system is working against us, in a sense, more than it is working to help us" (Statement of George Harper, Medicare Beneficiary, Before the U.S. Senate Finance Committee (http://www.kintera.org/TR.asp?a=hlL0LjMXLgKXLpI&s=svK7KiORLdK0JdM0G&m=mlKXJdOVJeL4H), February 7, 2008). * * * * Medicare Part D Appeals Help for Advocates Is Here! MRC's new Medicare Part D Appeals: An advocate's manual to navigating the Medicare private drug plan appeals process offers an easy-to-understand, comprehensive overview of the entire appeals process, including real-life case examples, a glossary of important appeals terms, a sample protocol for advocates, and links to important resources. Register for a FREE copy (http://www.kintera.org/TR.asp?a=aoJMIYNvF9JKJ5K&s=svK7KiORLdK0JdM0G&m=mlKXJdOVJeL4H) of this great resource. * * * * Medicare Private Health Plan Monitoring Project The Medicare Rights Center (MRC) would like to hear about your experience, or that of someone you know, enrolled in a private health plan. With information about what the issues are with Medicare Advantage plans, we will be able to demand that those problems be fixed. Submit your story at www.medicarerights.org/maplanstories.html (http://www.kintera.org/TR.asp?a=dhKSI7OHLcIRKfJ&s=svK7KiORLdK0JdM0G&m=mlKXJdOVJeL4H). * * * * The Louder Our Voice, the Stronger Our Message Asclepios--named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece--is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today (http://www.kintera.org/TR.asp?a=9nJKLVMrF9JBIUK&s=svK7KiORLdK0JdM0G&m=mlKXJdOVJeL4H). * * * * The Medicare Rights Center (MRC) is the largest independent source of Medicare information and assistance in the United States. Founded in 1989, MRC helps older adults and people with disabilities get high-quality, affordable health care. Visit our online subscription form to sign up for Asclepios at http://www.medicarerights.org/subscribeframeset.html (http://www.kintera.org/TR.asp?a=cgLQI4NDLcIIK4J&s=svK7KiORLdK0JdM0G&m=mlKXJdOVJeL4H). To unsubscribe from this mailing, please go to http://www.kintera.org/TR.asp?a=hlL0LjMYLjKWLmI&s=svK7KiORLdK0JdM0G&m=mlKXJdOVJeL4H To modify your profile and subscription preferences, please click go to http://www.kintera.org/TR.asp?a=aeJMIYNwFcJJJ2K&s=svK7KiORLdK0JdM0G&m=mlKXJdOVJeL4H
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