Medigap News

There has been an official response from the Centers for Medicare and Medicaid Services on improper Medicare Advantage Plan marketing:

In response to concerns about marketing practices in the insurance industry, seven health care sponsors have agreed to suspend marketing of private fee for service plans.

United Healthcare, Humana, Wellcare, Universal American Financial Corp., Coventry, Sterling and Blue Cross/Blue Shield of Tennessee signed the agreement with the Centers for Medicare and Medicaid Services.

We have written quite a bit about deceptive practices of some Medicare Advantage agents. In response to 2,700 complaints that were lodged with the Centers for Medicare and Medicaid Services between December 2006 and April 2007, 6 large angencies have imposed a voluntary marketing suspension of Medicare Advantage plans, effective June 22, 2007.

There are several guidelines that must be met before the suspension is lifted:

• All advertising, enrollment and sales materials must include disclaimer language provided by CMS.
• All representatives selling the product must pass a written test to demonstrate their thorough familiarity with both the Medicare program and the product they are selling.
• A provider outreach and education program must be in place to make sure providers have reasonable access to the plan’s terms and conditions of payment. Provider relations staff must be accessible to assist providers with questions about the plan.
• Outbound education and verification calls must be made to all beneficiaries requesting enrollment to make sure they understand the plan rules.
• Planned marketing and sales events must be sent to CMS and will include events sponsored by delegated brokers and agents, as well as those sponsored by the plan.
• Plan sponsors must provide a complete list of all representatives marketing a private fee for service product and authorize CMS to make that list available to state insurance departments upon request.

We believe this suspension is a great step in protecting seniors from ruthless, misleading sales agents who inappropriately push these Medicare Advantage plans whenever possible because of the high commissions. We will be following the progress closely. We truly hope that the mainstream media continues to cover this issue so we can bring more awareness to the issue in the minds of under-educated seniors.

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