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--- Begin Message ---Asclepios Your Weekly Medicare Consumer Advocacy Update Clean House March 6, 2008, Volume 8, Issue 10 If every Medicare private health plan provided good coverage and affordable access to medical services, the problem of abusive and deceptive marketing would be much more limited. Agents don't need to trick older adults into signing up for a plan that is a good deal. Consumers are less likely to feel deceived or pressured if the plan they get actually meets their needs. But many Medicare private health plans are not a good deal. According to a recent report by the Government Accountability Office (GAO), less than half of the eight million enrollees in so-called Medicare Advantage plans are in plans that have an annual limit on out-of-pocket spending for medical care. Any person with Medicare who drops retiree coverage or a Medigap supplement for one of these Medicare private plans no longer has protection against high medical bills. Of the Medicare private health plans that do provide an annual cap, many exclude specific services from the out-of-pocket limit. Over 2.7 million older adults and people with disabilities are in plans with such exclusions. More than 20 percent of these enrollees are in plans that exclude physician specialist services, various mental health services or home health care from the out-of-pocket limit. Forty percent are in plans that carve out Part B drugs, which include chemotherapy medicine from a doctor's office or a pharmacy and drugs to prevent the body from rejecting an organ transplant, from the annual cap. How many agents selling these plans warn their customers of these exclusions? How many agents point out that the plan they are hawking charges more for home health care or skilled nursing facilities than Original Medicare, plan deficiencies that GAO found could affect 1.5 million Medicare Advantage enrollees? Brokers and agents would rather sell a decent plan. It makes their job easier, builds good relationships with customers and helps them sleep at night. That is why insurers that offer lousy coverage tend to pay the highest commissions. High commissions create powerful incentives for abusive and deceptive marketing. If the Centers for Medicare & Medicaid Services (CMS) is serious about preventing marketing misconduct, the first order of business is to require Medicare private health plans to meet minimum standards for the coverage they provide. If CMS fails to act, Congress should step in. The time for empty talk is over. This week America's Health Insurance Plans—a lobbying association—came out with another plan to end marketing abuse. Unfortunately, it is mostly a restatement of existing marketing guidelines, such as the prohibition on door-to-door sales, or is so riddled with loopholes—a prohibition on cold calling would still allow calls as a follow-up to a mailing or to persons enrolled in any other insurance product the company offers—as to be meaningless. Congress standardized Medigap plans in the early 1990s. That legislation also regulated commissions and established a set of common rules for states to use in enforcing good marketing conduct by both agents and insurers. The result was a sharp drop in abusive marketing. The Medigap reforms provide a model for the reforms we need now to end the fraudulent and deceptive marketing of Medicare private health plans. The time to act is now. * * * * Medical Record "The proposal calls for a prohibition of door-to-door marketing, cross-selling, cold calls, and any inducements for beneficiaries to enroll. In addition, the statement calls for strengthening consumer disclosures, verifying that beneficiaries intended to enroll, additional agent and broker training and other protections. Karen Ignagni, President and CEO of AHIP, said that the AHIP Board wanted to send a strong message to Medicare beneficiaries that health insurance plans are calling for more government regulation to enhance consumer protections for every senior who is considering Medicare Advantage or Medicare prescription drug plans" ("Insurers Support Strengthened Federal Regulation and Oversight for Marketing to Medicare Beneficiaries (http://www.kintera.org/TR.asp?a=beJJIPNuFjJOJ3K&s=loKTKXOpG6LMISNyD&m=luL1KcOLJaJ1H)," America's Health Insurance Plans, March 4, 2008). "MA plans projected that, on average, beneficiaries in their plans would pay less in cost sharing than what their cost sharing would be in the [Original Medicare] program, although some MA plans projected that their beneficiaries would have higher cost sharing for certain service categories. For example, 19 percent of MA beneficiaries were in plans that projected higher cost sharing for home health services and 16 percent of beneficiaries were in plans that projected higher cost sharing for inpatient services. Because cost sharing was projected to be higher for some categories of services, beneficiaries who frequently used these services could have had overall cost sharing that would be higher than under [Original Medicare]" ( (http://www.kintera.org/TR.asp?a=erKPIYOGLmIVKdJ&s=loKTKXOpG6LMISNyD&m=luL1KcOLJaJ1H)Medicare Advantage: Increased Spending Relative to Medicare Fee-for-Service May Not Always Reduce Beneficiary Out-of-Pocket Costs, Government Accountability Office, February 2008). "I am a services coordinator working with low-income elderly and the disabled in public housing in a rural part of Virginia. I am alarmed by the recent increase in the number of residents who are having Medicare Advantage Plans aggressively marketed to them. Insurance agents seem to be targeting the lowest income residents they can find, particularly those already covered by the state-funded Medicaid program. One thing that is most deceptive about these plans are the other names given to many of them that are clearly designed to confuse the people they are attempting to sell to, which I assume are used to convince seniors that are being marketed to that this is actually a Medicare 'supplement' rather than an out-and-out replacement of their Medicare and Medicaid coverage. Is there anything that our government is going to do to reform this system? Or are they going to allow these insurance companies to perpetrate this scam on as many low-income elderly people they can find and continue to legally get away with it?" (Story submitted to the Medicare Private Health Plan Monitoring Project (http://www.kintera.org/TR.asp?a=huIVJ7PSKpL2InI&s=loKTKXOpG6LMISNyD&m=luL1KcOLJaJ1H), Medicare Rights Center, February 14, 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=anJHKMNqEiKPK3L&s=loKTKXOpG6LMISNyD&m=luL1KcOLJaJ1H) 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=gjITI4POJpKTIcI&s=loKTKXOpG6LMISNyD&m=luL1KcOLJaJ1H). * * * * 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=jmKZJdM0IsJ0JmL&s=loKTKXOpG6LMISNyD&m=luL1KcOLJaJ1H). * * * * 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=cfILKSNyGlINL2K&s=loKTKXOpG6LMISNyD&m=luL1KcOLJaJ1H). To unsubscribe from this mailing, please go to http://www.kintera.org/TR.asp?a=anJHLMMrFdJEIYK&s=loKTKXOpG6LMISNyD&m=luL1KcOLJaJ1H To modify your profile and subscription preferences, please click go to http://www.kintera.org/TR.asp?a=dqLNIVNDLgILK8J&s=loKTKXOpG6LMISNyD&m=luL1KcOLJaJ1H
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