" Open Season "

Sep 5, 2008

  1. allhealthandlife
    Online

    allhealthandlife Guest

    Asclepios
    Your Weekly Medicare Consumer Advocacy Update


    Open Season

    September 4, 2008; Volume 8, Issue 36



    Less than one month from now, private insurance companies will begin marketing
    their 2009 Medicare health and drug plans, hoping to convince people with
    Medicare to sign up for coverage for the new year. The marketing of Medicare
    private health plans has been plagued by abuse. Unscrupulous agents who troll
    senior housing complexes and even nursing homes have misrepresented or outright
    lied about the plan benefits and coverage, and cajoled or tricked frail older
    adults into signing enrollment forms in order to gain the commissions, bonuses
    and prizes the insurance companies award for these enrollments.

    The passage this summer of the Medicare Improvement for Patients and Providers
    Act over President Bush's veto sets some new ground rules for marketing this
    fall, including a ban on cold-calling and other unsolicited contact (such as accosting patients in hospital parking lots), and
    federal regulation of agent commissions. How these new rules are implemented and
    enforced will determine whether the Bush administration seizes, or squanders,
    its last chance to stop the abuse that has so far characterized the market for
    Medicare private health plans.

    Only aggressive oversight and enforcement—levying hefty fines and freezing
    enrollment—by the Centers for Medicare and Medicaid Services (CMS) will
    discourage plans from employing agents who flout the rules. (A little due
    diligence and oversight by the plans will uncover who most of these agents are.)

    CMS can send a signal of a new, no-nonsense approach with the marketing rules it
    sets for the new season. Here are three examples:

    No cold-calling prospective clients. Period. No exceptions, including
    cold calls that follow up mailings.
    No outrageous commissions, bonuses or promises of trips to Vegas that
    encourage agents to sell unsuitable plans to boost their sales volume. Reports of
    agents engaging in fraudulent and abusive
    marketing invariably lead back to plans that pay the highest
    commissions, or give volume-based bonuses. CMS needs to ensure high commissions
    are not used to push low-value plans.
    Clear explanation of plan benefits and coverage restrictions on all
    marketing material. In particular, the Summary of Benefits and the CMS plan
    finder must clearly list what, if any, services, are excluded
    from the financial protection provided by an annual limit on
    enrollee out-of-pocket spending.

    Asclepios
    Your Weekly Medicare Consumer Advocacy Update


    Open Season

    September 4, 2008; Volume 8, Issue 36



    Less than one month from now, private insurance companies will begin marketing
    their 2009 Medicare health and drug plans, hoping to convince people with
    Medicare to sign up for coverage for the new year. The marketing of Medicare
    private health plans has been plagued by abuse. Unscrupulous agents who troll
    senior housing complexes and even nursing homes have misrepresented or outright
    lied about the plan benefits and coverage, and cajoled or tricked frail older
    adults into signing enrollment forms in order to gain the commissions, bonuses
    and prizes the insurance companies award for these enrollments.

    The passage this summer of the Medicare Improvement for Patients and Providers
    Act over President Bush's veto sets some new ground rules for marketing this
    fall, including a ban on cold-calling and other unsolicited contact (such as accosting patients in hospital parking lots), and
    federal regulation of agent commissions. How these new rules are implemented and
    enforced will determine whether the Bush administration seizes, or squanders,
    its last chance to stop the abuse that has so far characterized the market for
    Medicare private health plans.

    Only aggressive oversight and enforcement—levying hefty fines and freezing
    enrollment—by the Centers for Medicare and Medicaid Services (CMS) will
    discourage plans from employing agents who flout the rules. (A little due
    diligence and oversight by the plans will uncover who most of these agents are.)

    CMS can send a signal of a new, no-nonsense approach with the marketing rules it
    sets for the new season. Here are three examples:

    No cold-calling prospective clients. Period. No exceptions, including
    cold calls that follow up mailings.
    No outrageous commissions, bonuses or promises of trips to Vegas that
    encourage agents to sell unsuitable plans to boost their sales volume. Reports of
    agents engaging in fraudulent and abusive
    marketing invariably lead back to plans that pay the highest
    commissions, or give volume-based bonuses. CMS needs to ensure high commissions
    are not used to push low-value plans.
    Clear explanation of plan benefits and coverage restrictions on all
    marketing material. In particular, the Summary of Benefits and the CMS plan
    finder must clearly list what, if any, services, are excluded
    from the financial protection provided by an annual limit on
    enrollee out-of-pocket spending.
     
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