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Compelling Evidence
June 28, 2007 • Volume 7, Issue 26This past April, the Medicare Rights Center launched the Medicare Private Health Plan Monitoring Project to learn about the experiences of people with Medicare enrolled in these plans. In the past two months, we have received story after story from people with Medicare, their family members and friends, counselors and caseworkers about the problems they have encountered dealing with these plans.
The insurance industry is reaping billions of dollars in overpayments from Medicare. Hoping to keep that gravy train rolling, the industry touts the extra benefits and better coverage in private plans. But it won’t brag about the higher cost sharing some plans charge for chemotherapy and other medicines compared to Part B under Original Medicare. It won’t boast about the Florida couple whose plan told them it would cover surgery in their local hospital but then denied payment claiming the hospital is not in the plan’s network and so they must pay for the surgery themselves.
The insurance industry insists that private plans are especially beneficial for low-income people with Medicare. But it keeps quiet about the people with Medicare and Medicaid who enroll in these plans with the promise of extra benefits and end up being charged copayments they did not have to pay under Original Medicare.
The insurance industry argues that private plans offer consumer choice and empowerment. But it leaves out the abusive marketing tactics sales agents use to get people to enroll. There are stories about agents claiming to represent Medicare, aggressively pushing plans on people with Medicare in their homes and workplaces, forging signatures, leaving out crucial information about costs and restrictions, lying about how the plans work or even threatening people with loss of all their Medicare or Medicaid benefits if they do not join the plan.
These stories are disturbing, serious evidence of a program that prioritizes profits far above the health and well-being of its enrollees. We have also heard from insurance sales agents and others who have worked for insurance companies, whose testimonials confirm what people with Medicare have experienced. One sales agent wrote to us about being troubled by the pressure to sell Medicare Advantage plans, regardless of whether or not they were right for a particular customer. He told us about the company’s emphasis on earning profits and the lack of knowledge his superiors had about the plans.
Our representatives in Congress must choose who they will listen to when it comes to private Medicare health plans: slick insurance lobbyists armed with their talking points and scare tactics or the voices of ordinary people across the country whose stories call for cutting the overpayments and holding plans accountable for their actions. It’s time for them to decide.
Tell your senators and representative to stop the overpayments to private plans.
Read stories submitted to the Medicare Private Health Plan Project.
Medical Record
“Currently, program payments for MA [Medicare Advantage] plan enrollees are well above 100 percent of FFS [traditional fee-for-service Medicare] expenditure levels: on average, MA program payments are at 112 percent of Medicare FFS levels…To pay MA plans appropriately, the Commission recommends that benchmarks—the basis of plan payments in MA—should be set at 100 percent of Medicare FFS expenditures” (Testimony of Mark E. Miller, Executive Director of the Medicare Payment Advisory Commission, before the U.S. House of Representatives Committee on the Budget, June 28, 2007).
“I have found out that the plan my wife and I are enrolled in does not cover any hospital in our county. We did apply for permission to have a knee replacement surgery done in the Naples Hospital and it was O.K.'d, but now I have been told that it would be treated as an ‘out-of-network’ hospital and the cost would be higher. In addition the cost of this hospital stay would not count as ‘in network’ for the maximum payment limit” (Story submitted to the Medicare Private Health Plan Monitoring Project, June 13, 2007).
“I am director of supportive services at an affordable independent apartment complex. Several of our residents were called last week by agents who said they were hired by Medicare. The agents asked them if they had received their 2007 Medicare and You book and if they were aware of the new benefits covered by Medicare for dental, vision and hearing. The agents asked to make appointments with the residents to come and give them the information. I checked with the local Social Security office and called the company directly. The agents were from a private insurance company attempting to sell a Medicare Advantage plan” (Story submitted to the Medicare Private Health Plan Monitoring Project, May 17, 2007).
“Every time I sold a plan I felt like I was never able to give the customer the facts, which I wanted to be able to do to advise them as to which plan would work best for them. I like to do the right thing for people and I have to go to bed every night knowing that I have done the right thing for people. These plans left me awake nights wondering that very question! It could have been easier to do my job doing what was right for the customer, but the company imposed minimums to sell the MA plans. The things that I heard from VPs of the company were detestable in regards to the profits that were being made off of these products” (Story submitted to the Medicare Private Health Plan Monitoring Project, June 18, 2007).
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***** The Medicare Rights Center (MRC) would like to hear about your experience, or that of someone you know, enrolled in a private health plan. With information about what the issues are with Medicare Advantage plans, we will be able to demand that those problems be fixed.
Medicare Private Health Plan Monitoring Project
Submit your story at http://www.medicarerights.org/maplanstories.html.
*****
The Louder Our Voice, the Stronger Our Message Asclepios — named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
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