Majority report from US Senate Finance Committee finds seniors topic to advertising and marketing scams from well being insurers.
Seniors signing up for Medicare Benefit (MA) throughout open enrollment (which ends Dec. 7) have extra causes to fret now that reporters at Kaiser Well being Information, MedPage Right this moment and elsewhere have continued to uncover important issues with these personal managed care plans.
Throughout open enrollment, reporters have a accountability to elucidate the issues seniors could face with MA plans and to warn them about misleading advertising and marketing practices.
And well being care journalists ought to ask officers on the federal Facilities for Medicare and Medicaid Providers (CMS) why it units increased charges for medical health insurance brokers promoting MA plans than the charges it units for brokers to register seniors in Medicare Complement (additionally referred to as Medigap) plans that is likely to be extra acceptable for his or her wants.
We should always pose this similar query to members of Congress involved concerning the solvency of the Medicare belief fund.
For extra on how spending for MA plans pertains to Medicare solvency, see this deep dive from Tony Pugh who covers Medicare for Bloomberg Legislation, “Growth of Private Medicare Plans Clouded by Payment Questions.” In his article, he wrote, “Of their 37-year historical past, personal Medicare managed care plans have by no means produced combination financial savings for this system, the Medicare Payment Advisory Commission reported.” Additionally, he famous that CMS paid MA plans $350 billion final 12 months to cowl greater than 29.7 million seniors, virtually 46% of Medicare’s 64.6 million beneficiaries.
Last month, we explained a number of the issues Medicare members face when enrolling in MA plans, together with frequent care denials, slim networks that restrict members’ alternative of physicians and hospitals and the difficulty members face getting out of MA for higher protection in Medigap plans.
Senate report on advertising and marketing scams
On Nov. 4, Cheryl Clark reported for MedPage Today that seniors searching for to enroll in MA plans usually fall sufferer to advertising and marketing scams and deception that end in beneficiaries getting switched with out their information to plans that don’t cowl their suppliers or their wants. For that article, she cited a brand new 27-page report from the Majority Workers of the U.S. Senate Committee on Finance, “Deceptive Marketing Practices Flourish in Medicare Advantage.”
After amassing complaints from 14 states, Medicare advocacy teams and the federally funded State Well being Insurance coverage Help Packages (SHIP), the committee discovered a constant nationwide image of misleading practices, together with seniors going through bait-and-switch schemes and aggressive and sneaky techniques to get seniors to enroll in MA plans, she added.
For its report, the committee collected complaints from 14 states, Medicare advocacy organizations and the federally funded State Well being Insurance coverage Help Packages (SHIP). Because of this, the committee discovered a constant nationwide image of misleading practices, Clark added.
Reuters columnist Mark Miller additionally lined the Finance Committee’s report, noting that final 12 months, CMS acquired 39,617 complaints concerning the advertising and marketing of Medicare Benefit and Half D drug plans, a rise of 155% over the variety of complaints acquired in 2020.
Crackdown on deceptive advertisements
As we famous in our earlier protection, Clark reported that CMS officers cracked down this 12 months on deceptive and incorrect advertisements from well being insurers selling the low premiums and extra advantages obtainable in MA plans. Along with receiving complaints about complicated, deceptive, or inaccurate advertisements for MA plans, CMS stated it additionally used secret consumers to doc misleading phone pitches from brokers and brokers promoting MA plans.
Then CMS despatched letters to all MA well being insurers that some gross sales brokers have been pressuring beneficiaries and failing to supply correct or full data to assist seniors make knowledgeable enrollment choices.
Larger funds to MA brokers
One purpose seniors face deceptive advertisements and misleading gross sales techniques is that CMS units excessive charges for brokers to steer new Medicare members to MA plans, as Clark reported on Oct. 14.
Christopher Westfall, an insurance coverage dealer for Senior Savings Network, advised Clark that relying on the plan he’s promoting, he will get paid about twice as a lot in commissions for enrolling a brand new beneficiary into an MA plan for subsequent 12 months (that means 2023) in contrast with enrolling that very same individual right into a Medigap plan. Westfall is licensed to promote well being plans in 47 states.
Earlier this month, Gretchen Jacobson, vp of the Medicare Program on the Commonwealth Fund, reported on Twitter that brokers’ commissions usually are increased if seniors enroll in MA plans quite than in conventional Medicare plus a Medicare Half D (prescription drug and a Medigap plan). Final 12 months, The Commonwealth Fund lined this matter in a report, “Agent Commissions in Medicare and the Impact on Beneficiary Choices.”
“For instance, for 2022, CMS has set the utmost nationwide fee for first-time enrollment in MA at $573 per beneficiary for many components of the nation,” the report famous.
As soon as members are enrolled in MA plans, well being insurers can make more cash by doing well being danger assessments on members and reporting that these members have excessive well being dangers, Jacobson famous on Twitter.
Well being plan audits revealed
Fred Schulte and Holly Hacker recently reported for KHN and NPR that newly launched federal audits present widespread overcharges and different errors from MA plans and that some plans overbilled the federal government greater than $1,000 per affected person per 12 months on common. A few of these overcharges doubtless resulted from well being insurers doing well being danger assessments on members and discovering extra well being dangers, thus rising what Medicare pays for these beneficiaries.
“The federal government’s audits uncovered about $12 million in internet overpayments for the care of 18,090 sufferers sampled, although the precise losses to taxpayers are doubtless a lot increased,” Schulte and Hacker wrote. The nation’s largest well being insurers run MA plans, that are a fast-growing different to unique Medicare, they added.
The summaries of 90 authorities audits present that the CMS examined well being plan billing information from 2011 by way of 2013. KHN acquired the information completely by way of a lawsuit the information website filed in 2019 below the Freedom of Info Act.
