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Joint Oversight
March 20, 2008 • Volume 8, Issue 12Insurance companies have been telling Congress not to give state insurance departments the authority to crack down on fraudulent and deceptive marketing of Medicare private health plans, arguing that this would result in dual regulation by both the federal and state governments. The companies act as if having states and the federal government share oversight and enforcement represents some sort of aberration, a venture into an unmapped regulatory swamp.
In reality, joint state-federal oversight of Medicare providers is the norm. Doctors are licensed at the state level, but must also abide by federal Medicare rules. Nursing homes must meet both federal and state standards, and the Centers for Medicare & Medicaid Services (CMS) uses state agencies to inspect nursing homes compliance with federal standards. It could not be otherwise. CMS simply does not have the capacity to stand in for local authorities in their oversight of medical providers, even when Medicare is paying those providers with federal dollars.
Similarly, CMS on its own cannot substitute itself for the experience and capabilities of state insurance departments when it comes to policing the marketplace for Medicare insurance products. The states have done a good job enforcing a national set of rules governing Medigap supplemental insurance, but they are barred from protecting consumers from companies engaged in predatory marketing of Part D drug plans or Medicare private health plans—so-called Medicare Advantage plans.
The Medigap regulatory model should apply to Medicare Advantage. No one is arguing for 50 sets of rules or wants to make insurance companies get their brochures approved by every state insurance department. What consumers want is to put an end to abusive marketing, and the best way to do that is to untie states’ hands and allow them to enforce tough national regulations that would address the problem. Make your voice heard. Please urge your senator to cosponsor S. 1883, the Accountability and Transparency in Medicare Marketing Act of 2007.
Medical Record
“I am a social worker who assists low-income elderly people in a public housing project in Virginia. One problem I have encountered in working with elderly residents on these Medicare Advantage Plans is the aggressive manner in which these products are marketed. Many people I deal with are on Medicaid and do not need these extended insurance plans, but insurance agents still push these plans on low-income people to make their commissions. Many of these people do not comprehend what they are signing up for. I've encountered this problem on several occasions in the last couple years in the facility I work in. I do not think the government is regulating these insurance agents in the way that they should. Many of these insurance salespeople act as 'free agents,' selling insurance locally for large national companies. This makes it difficult when you wish to file a complaint.
"In two cases I was able to disenroll the residents who were unhappy with their plans during the Open Enrollment Period in November of last year. But I'm currently working with an 89-year-old resident who signed papers yesterday that she did not comprehend with an agent who showed up at her door selling private Medicare policies. She and I both contacted the selling agent to cancel the policy. The agent rudely refused to withdraw the papers she'd signed and basically told her 'it was not his problem' and to 'just take it up with the company!'" (Story submitted to the Medicare Private Health Plan Monitoring Project, Medicare Rights Center, February 6, 2008).
“...AHIP's proposals amount to endorsing the status quo regulatory scheme in which MA plans nationwide are regulated by one entity—CMS—that does not appear to have the capacity to provide adequate oversight. AHIP's proposal would preserve an unworkable system that divorces oversight of agents from oversight of the plans they work for, complicating the task of enforcing consumer protections." (Letter on Medicare Marketing to Senators Baucus and Grassley, Center for Medicare Advocacy, Medicare Rights Center and California Health Advocates, March 12, 2008).
"'State insurance regulators have long-standing institutional knowledge, expertise and resources upon which to construct appropriate marketplace safeguards,' McRaith said. 'A return of state oversight authority over Medicare Advantage and prescription drug plans would allow us to better protect seniors from companies and agents engaged in unscrupulous or abusive sales practices.'" (“State Insurance Regulator Testifies to Need for Greater Oversight of Medicare Marketplace," National Association of Insurance Commissioners, February 7, 2008).
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Medicare Part D Monitoring Project
The Medicare Rights Center (MRC) would like to hear about your experience, or that of someone you know, enrolled in a Medicare private drug plan. With information about what the issues are with Medicare Part D, we will be able to demand that those problems be fixed.
Submit your story at http://www.medicarerights.org/partdstories.html.
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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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The Medicare Rights Center (MRC) is the largest independent source of Medicare information and assistance in the United States. Founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care.
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