Asclepios
Congress Must Stop Predatory Marketing
May 8, 2008 • Volume 8, Issue 19
Today, the Centers for Medicare & Medicaid Services (CMS) proposed new rules to govern the marketing of Medicare private health plan, making this the latest attempt by the administration to put an end to the deceptive, fraudulent and aggressive marketing of these plans.
Congress, which is considering its own sets of marketing rules, should bear in mind two things:
• A proposal is not a promise.
• Someone has to enforce the rules.
In the past, CMS has proposed tough rules that run counter to the desires of very powerful special interests, but dropped or substantially weakened its proposal in the final rule.
When this regulation is finalized, will it still prohibit plan agents from making harassing phone calls to solicit new enrollees? Or will it create the loophole desired by insurance companies and allow cold calls that follow a mailing?
Will CMS issue tough rules prohibiting the exorbitant agent commissions that drive the most aggressive marketing? Or will the agency allow companies to skirt the rules by offering agents bonuses and prizes for delivering volume, a loophole allowed even in the draft regulation issued today?
Congress needs to follow through now and enact laws that prohibit cold-calling, rein in agent commissions and take other steps to stop abusive marketing.
Even the toughest rules are meaningless unless they are enforced. CMS has already prohibited door-to-door marketing of Medicare private health plans. It still goes on all the time. Now, CMS rightly proposes to prevent agents from accosting older Americans on the street as they are heading in to the clinic. Who is going to enforce this prohibition?
CMS does not have the personnel or the expertise to enforce marketing rules at the local level. State insurance departments, however, have been conducting such enforcement for decades. Congress needs to find a role for states to hold both agents and plans to account for marketing misconduct.
Older adults and people with disabilities who are bullied and deceived into a Medicare private health plan wind up saddled with medical bills they cannot pay and have their medical care interrupted until they can return to Original Medicare. It is time for this abuse to end.
Medical Record
“My father works at a service station pumping gas and checking the oil and tires. A sales agent from a Medicare Advantage plan came to his place of employment to talk to him. She told him the policy would pay in addition to his supplemental insurance. My father has hearing problems and at the time had not received his hearing aids. While he continued to work, the agent still talked to him about the plan. He told her several times that he did not need this. She persisted and my father did sign the papers. She told him that he could not go wrong with this policy because it was free and would pay what his supplemental plan did not. My father received information from the plan in April, stating that he was approved for enrollment on March 1. He showed me the information, and I called the plan to try to disenroll. My father did not understand that he did not have Medicare anymore. On April 16, I faxed a letter to the plan, requesting that he be disenrolled immediately. They sent a letter on April 30 saying he could only disenroll under special circumstances. My father has become very upset and confused by all of this. He called the sales agent again and she told him that it would be easy to cancel the plan, that she had to do it all the time. She still has not done anything to help my father. I have called and left messages with this agent three times. She will not return my calls. I have contacted the insurance company multiple times. A caseworker from the MS Senior Medicare Patrol has been working with us trying to get my father disenrolled. I have never been treated this way by any other insurance company. ” (Story submitted to the Medicare Private Health Plan Monitoring Project, Medicare Rights Center, May 2007).
“We clarify that the prohibition on door-to-door solicitation includes other unsolicited instances of direct contact . . .[and] would help prevent inappropriate conduct on the part of agents in aggressively pursuing the marketing of Part C and D plans to beneficiaries (for example, approaching beneficiaries directly in parking lots)” (Proposed Revisions to the Medicare Advantage and Prescription Drug Benefit Programs, CMS, May 2008).
“Congress must resist the insurance lobby’s efforts to divert it from the roadmap to consumer protection laid out in the 1990 reform of the Medigap marketplace, and establish a set of tough national marketing rules enforced jointly by federal and state governments, and simplified, standardized coverage choices for Medicare Advantage enrollees” (Letter to House and Senate Leadership from Unions and Advocacy Goups, April 2008).
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