State: Be Wary of Medicare Plan Pitches
Posted on: Tuesday, 26 July 2005, 15:01 CDT
Jul. 26--All across the state, private Medicare plans have sales representatives knocking on people's doors with offers of prescription coverage plans and other benefits not yet available through traditional government-run Medicare.
Insurance Commissioner Jim Long wants customers to be careful before they sign up for any of them. His office issued a warning Monday, after receiving more than 30 complaints of high-pressure sales tactics.
Some Medicare enrollees have signed up only to discover that their doctor or hospital doesn't accept the private plan. People with health insurance through Medicaid, the state and federal health insurance program for the poor, have been steered toward Medicare HMOs with significantly less generous benefits.
In a few cases, people have complained to regulators that their parents had been pressured into enrolling.
Many private health insurers provide Medicare coverage, which enrollees may select instead of traditional government-run Medicare. Private plans are known as "Medicare Advantage" plans.
What carriers are authorized to sell Medicare Advantage plans in North Carolina?
To date, Humana, Partners National Health Plans, Sterling, Unicare Life & Health and United Healthcare. PacifiCare will be available Sept. 1.
In addition to direct mail and print, radio and television advertising, insurers may hold public sales meetings. Medicare does not allow "cold" calling or door-to-door sales. However, plans may ask current members and prospective clients for the names and contact information of friends and members may be interested.
The state Seniors' Health Insurance Information Program provides free information and counseling to older adults who have questions about Medicare, including whether private coverage is a good option. You can call the program at (800) 443-9354.
Regulators said they have no evidence that any private Medicare plan has broken the law.
"There's just a lot of aggressive sales tactics going on," said Carla Obiol, director of the Seniors' Health Insurance Information Program or SHIIP, a free service run by the insurance department. SHIIP operates a toll-free information line for Medicare members.
Federal legislation passed in 2003 sharply increased what private plans are paid to cover Medicare members, and laid out plans for a new Medicare prescription drug benefit, which will be available in January. The changes gave insurance carriers incentive to target Medicare business. Since the changes took effect, the number of private insurers offering Medicare coverage in North Carolina has tripled.
Today there are six carriers offering more than 20 private Medicare plans.
Private coverage sounded like a great deal to Burgess Jernigan, 56.
An insurance salesman knocked on the disabled Bertie County man's door in June, offering a free Medicare plan through Humana. The salesman said Jernigan's prescriptions for blood pressure and arthritis pills would cost $10 apiece.
The salesman pulled out a booklet that showed the plan was good in Bertie County and said Jernigan would pay less for hospital and physician care if he signed up.
Jernigan enrolled in the Humana Gold Choice plan, as did his 79-year-old mother.
But when Jernigan's mother went to Bertie Memorial Hospital in Windsor, hospital staff said her coverage was no good there. Jernigan called University Health Systems, which owns Bertie Memorial, and confirmed that the hospital system does not participate with Humana.
Humana doesn't use a network, so in theory, members may use any hospital or doctor.
However, providers must agree to accept payment from Humana or members cannot use their coverage.
"If you can't go to the hospital, what good is it?" said Jernigan, who plans to drop Humana and return to traditional Medicare.
He was able to use the Humana plan at his local pharmacy, where he estimated the coverage saved him about $110 on medicine.
Patrick Farley, director of Humana's North Carolina Medicare business, said Humana is working to increase the range of providers that accept its payments terms.
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Source: The News & Observer
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