Insurance Commissioner Jim Long urged Medicare recipients - particularly senior citizens - and their families to be aware that some health insurance companies are employing aggressive marketing tactics to sell Medicare Advantage products which may mislead consumers. According to the Department's respected Seniors' Health Insurance Information Program (SHIIP), many Medicare beneficiaries are receiving bad financial advice leading them to make decisions which are not in their best interest.
Medicare Advantage plans include HMO, PPO, Medicare Medical Savings Accounts and Private- Fee-for-Service products. Recent Medicare reform laws have resulted in an explosion of these products hitting the North Carolina market, with now more than 10 companies offering some type of Medicare Advantage plan. With this much competition, Long says, companies are fighting for business. "If the number of complaints fielded by SHIIP staff is any indication, some of these companies have resorted to using questionable tactics to win customers," he warned.
Senior citizens are particularly at risk, SHIIP officials believe. Complaints about aggressive marketing tactics range from insurance agents soliciting seniors at discount stores to "cold calls" by agents wishing to set up sales appointments in homes. The complaints have included incidents of agents advising the seniors on financial decisions, such as canceling other insurance policies, which may not have been in the best interest of the client. Commissioner Long and the staff at SHIIP are extremely concerned that this type of solicitation may lead citizens to make poor decisions that could negatively affect their insurance coverage.
Take the story of Mrs. Thomas Gray. She called the SHIIP office to report that an agent visited her home under the pretense of offering her the additional coverage she was entitled to after signing up for a Medicare Part D plan. "He said this was free insurance for me and my husband and that it wouldn't change our Medicare coverage. He told us it would offer us more coverage and not cost anything more than the Part B premium we were currently paying. He said it worked just like Medicare. We signed right then," said Mrs. Gray. She and her husband later discovered that they had unknowingly enrolled in a Private-Fee-For-Service Program that was not accepted by their doctor. "My husband and I felt we were misled," she said. After calling SHIIP, she was able to disenroll from the plan and return to Original Medicare.
Things that Medicare recipients should know about Medicare Advantage (also known as Medicare Health) plans:
You should fully understand the details and terms regarding Medicare Advantage plans, and the plan you are looking at specifically. Some things to note include:
- these plans are part of the Medicare program and provide Part A, Part B and sometimes additional benefits
- you may have to pay a monthly premium, or you may have out-of-pocket costs such as copays
- Medigap or Medicare Supplement policies do not coordinate with any Medicare Advantage plan
Not all doctors or hospitals accept all Medicare Advantage plans. Make sure your healthcare providers will accept the plan you are considering before you buy it, or you may be stuck paying for all your charges yourself! Call your doctor and ask before you buy.
Insurance agents cannot come to your home without permission. If they call you to schedule an appointment, first do the following:
- Get the agent's name, the company name, and a phone number.
- Call back to verify the person is who he says he is. If you have any doubts, SHIIP can tell you if that person is a licensed agent; call 1-800-443-9354.
- Try to schedule the appointment for a time when a trusted family member or financial advisor can be with you. Someone you trust can help you make a decision in your best interest without giving in to any sales pressures from the agent.
- If you have other health insurance, such as your employer plan through retiree coverage, check with that plan before you enroll in a Medicare Advantage plan.
Do not be pressured into making quick decisions. The agent can wait for you to think this over, discuss it with someone else, call your doctor and/or call SHIIP for assistance. SHIIP counselors are specifically trained to assist you with your health insurance questions. Call 1-800-443-9354.
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