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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.
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.
