Some Health Insurance Agents Might Be Violating Medicare Rules By Aggressively Marketing Fee-for-Service Plans

Health care advocates say that some insurance agents might have violated Medicare rules by soliciting fee-for-service plans to businesses door-to-door and that some agents are targeting beneficiaries with cognitive problems or limited English skills, the San Francisco Chronicle reports. According to the Chronicle, the number of fee-for-service plans increased in the past year, and Congress in 2006 eased certain enrollment restrictions. The Chronicle reports that advocates who have interviewed consumers said some agents focused their efforts on low-income beneficiaries who also are eligible for Medicaid or Medicare, which often provide more comprehensive and less expensive coverage. Agents’ commissions on Medicare fee-for-service plans can be as much as five times higher than commissions for some Medicare prescription drug plans. At least two insurers are investigating complaints alleging inappropriate marketing practices by their agents and independent sales representatives. CMS also is investigating cases that have been reported. Neither advocates nor regulators know how many complaints have been made about fee-for-service plans. Jeff Flick, regional CMS administrator in San Francisco, said beneficiaries who have been inappropriately enrolled in a plan will be allowed to change their coverage. He said, “We hold the plans responsible. They have to take responsibility for the things their agents or broker or representatives do” (Colliver, San Francisco Chronicle, 1/26).

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