This week’s question from Kadie
My father was moved to another Advantage Plan in March by an agent who cold called him. He doesn’t remember giving permission to do an application and never got any correspondence from the agent, nor his name or contact information. We came to find out he was moved to a plan where his UPMC doctors weren’t even in network! When we called the company, they said he couldn’t change back because it was outside of any election period. How can this be allowed to happen? Aren’t there regulations on agents and companies? What are his rights in this situation and what can we do to make sure it doesn’t happen again?
Answer
The Wild West
We’ve never seen so much unethical and illegal practices by rouge agents in the 14 years The Health Insurance Store has been in business. It makes me extremely angry. The bottom line is the Medicare Advantage market has become extremely competitive with more and more agents entering the field. And commissions are very generous, which can be motivation to behave badly, unfortunately. There are also large organizations who are pouring huge money into TV advertising and paying washed up actors and athletes who are willing to appear in misleading commercials that use bait and switch tactics and a boiler room style of selling where agents are taught to change everyone who calls regardless of the fit for the Medicare beneficiary. What happened to your father is going on all across the country to countless seniors who are literally being preyed upon.
There are regulations set forth by CMS on agents, but unfortunately, not enough is being done to combat what is going on. And with most Advantage Plan companies allowing applications to be done online from anywhere in the country, it’s made it easier than ever for unscrupulous agents to take advantage of seniors. I have no clue why the Centers for Medicare and Medicaid (CMS) continues to allow these commercials to be aired. Organizations are luring people with the possibility of getting as much as $2000 extra in one’s Social Security check, the amount of the Part B premium. However, only those who are on Medical Assistance qualify. But once they have a senior citizen on the phone, they will say anything to get them to switch, often focusing on trivial benefits such as a $5 difference in PCP co-pay, $10 more per quarter in OTC allowances, or a lower premium; not overall co-pays, MOOP, or the cost of a 5-day hospital stay. I mentioned in a recent column that I had a client who talked to an agent who convinced her it was best to take a plan that cost nothing while refunding $40 per month of her Part B premium. What he failed to explain was the hospital co-pay for a 5-day stay was going to be almost $2,000 as opposed to $275 and the coinsurance for an outpatient surgery was 20% as opposed to $200. She had her Pacemaker replaced not long after she was enrolled and got a bill of $6,600. The guy who did this to her should be in jail. And again, she had no idea of the man’s name. He never even sent her a copy of the application or his card. Turns out the agent was based in California.
In addition, we continue to hear that people are getting numerous unsolicited phone calls, which is not legal to do if the goal is to talk about or sell Advantage Plans. But there’s a fine line here and unless the call is being recorded, there would be no way to prove what was discussed.
Make Your Voice Heard
What needs to be done every single time a senior citizen is the victim of unscrupulous or illegal behavior is to make a complaint with Medicare, which can be done online or by calling 1-800-Medicare. If a commercial prompted the call to an 800# and you felt duped by the advertisement, I would include that in the complaint. In the case of Kadie’s dad or my client who didn’t have any contact information of the agent in question, that can be requested by calling the company one was conned into enrolling in. An agent who gets multiple complaints can be disciplined, suspended from selling certain company’s plans, or lose his or her license.
If enough people make complaints, I believe something will be done. I would also suggest calling your state representatives and senators as well and make them aware of what’s happening.
However, I’m very concerned it’s going to continue for a couple of reasons. There’s another Medicare Election Period that starts January 1st and runs through March 31st, called Open Enrollment. Those on Medicare A and B can still move from one Advantage Plan to another during this time, which is what the goal of those scoundrels who are cold calling and on the other end of the 800 numbers. We’re going to continue to see those same faces on TV imploring people to call and they may be around all year now. Here’s why. More and more companies have plans that have been awarded a Five Star Rating from CMS. People can enroll in these plans outside of the Annual and Open Enrollment Periods. I’m sure the following is going to be used to sucker people off their current plans. I can hear it now. “You don’t want that plan. It’s only got four and a half stars. This one has five.” Please do not be seduced by star ratings. They have nothing to do with the overall value of a plan in terms of premiums, co-pays, MOOP or ancillary benefits. There’s a plan that costs $300 and has a MOOP over $7,000 that gets Five Stars, while one that costs less than $30 and has a MOOP under $5,000 with very similar co-pays and ancillary benefits gets a rating under five.
Congressional Input
As far as one’s rights in these situations, other than filing a complaint or grievance, it is possible to get back on your previous plan, but that would be at Medicare’s discretion. You would want to ask them to do that when making the complaint.
I hate to say this, but I don’t think the abhorrent behavior and tactics are going to stop until CMS or Congress outlaws these commercials and comes down harder on agents and agencies who are doing business with no care as to the best interests of those they speak with. If they do, I hope while they’re at it, they limit the amount of advertising and mailers companies can do. It’s flat out overwhelming to so many seniors. I hear that complaint all the time.
Thank you!
If you have any questions or concerns regarding this column topic, or would like to make an appointment for a no-cost consultation, please feel free to give us a call – we would be happy to help. I’d like to remind everyone that I do a live call-in talk show called Medicare A to Z every 1st and 3rd Monday of the month on WMBS Uniontown, 590AM and 101.1FM, from 1 to 3 PM. You can listen in on their website, wmbs590.com.
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