November 30, 2023

Uncle Sam Desires You … to Assist Cease Insurers’ Bogus Medicare Benefit Gross sales Techniques

After an unprecedented crackdown on deceptive promoting claims by insurers promoting personal Medicare Benefit and drug plans, the Biden administration hopes to unleash a particular weapon to ensure corporations comply with the brand new guidelines: you.

Officers on the Facilities for Medicare & Medicaid Providers are encouraging seniors and different members of the general public to grow to be fraud detectives by reporting deceptive or misleading gross sales ways to 800-MEDICARE, the company’s 24-hour info hotline. Suspects embrace postcards designed to appear like they’re from the federal government and TV adverts with celebrities promising advantages and low charges which might be obtainable solely to some individuals in sure counties.

The new rules, which took impact Sept. 30, shut some loopholes in present necessities by describing what insurers can say in adverts and different promotional supplies in addition to throughout the enrollment course of.

Insurance coverage corporations’ promoting campaigns kick into excessive gear each fall, when seniors should buy insurance policies that take impact Jan. 1. Folks with conventional authorities Medicare protection can add or change a prescription drug plan or be part of a Medicare Benefit plan that mixes drug and medical protection. Though personal Benefit plans provide further advantages not obtainable beneath the Medicare program, some companies require prior authorization and beneficiaries are confined to a community of well being care suppliers that may change anytime. Beneficiaries in conventional Medicare can see any supplier. The open enrollment season ends Dec. 7.

Catching Medicare Benefit plans that step out of line isn’t the one purpose to maintain an eye fixed out for advertising and marketing scams. Correct plan info can assist keep away from enrollment traps within the first place.

Though insurers and advocates for older adults have typically welcomed the brand new truth-in-advertising guidelines, compliance is the massive problem. Anticipating beneficiaries to observe insurance coverage firm gross sales pitches is asking quite a bit, mentioned Semanthie Brooks, a social employee and advocate for older adults in northeast Ohio. She’s been serving to individuals with Medicare type by way of their choices for almost 20 years. “I don’t suppose Medicare beneficiaries ought to be the police,” she mentioned.

Selecting a Medicare Benefit plan will be daunting. In Ohio, for instance, there are 224 Benefit and 21 drug plans to select from that take impact subsequent 12 months. Eligibility and advantages range amongst counties throughout the state.

“CMS must be taking a look at how they’ll educate individuals, in order that after they hear about advantages on tv, they perceive that it is a promotional commercial and never essentially a profit that they’ll use,” Brooks mentioned. “For those who don’t notice that these adverts could also be fraudulent, you then received’t know to report them.”

The company depends on beneficiaries to assist enhance companies, Meena Seshamani, CMS’ Medicare director, advised KFF Well being Information in a written assertion. “The voices of the individuals we serve make our packages stronger,” she mentioned. Beneficiary complaints prompted the federal government’s motion. “That’s why, after listening to from our group, we took new vital steps to guard individuals with Medicare from complicated and doubtlessly deceptive advertising and marketing.”

Though about 31 million of the 65 million individuals with Medicare are enrolled in Medicare Benefit, even that might not be sufficient individuals to observe the tsunami of promoting on TV, radio, the web, and paper delivered to precise mailboxes. Final 12 months greater than 9,500 adverts aired every day throughout the nine-week advertising and marketing interval that began two weeks earlier than enrollment opened, in keeping with an analysis by KFF. Greater than 94% of the TV commercials have been sponsored by well being insurers, brokers, and advertising and marketing corporations, in contrast with solely 3% from the federal authorities touting the unique Medicare program.

Throughout only one hourlong Cleveland information program in December, researchers discovered, viewers have been handled to 9 Benefit adverts.

For the primary time, CMS requested insurance coverage and advertising and marketing corporations this 12 months to submit their Medicare Benefit tv adverts, to ensure they complied with the expanded guidelines. Officers reviewed 1,700 commercials from Might 1 by way of Sept. 30 and nixed greater than 300 deemed deceptive, in keeping with information studies. An extra 192 adverts out of 250 from advertising and marketing corporations have been additionally rejected. The company wouldn’t disclose the whole variety of TV commercials reviewed and rejected this 12 months or whether or not adverts from different media have been scrutinized.

The brand new restrictions additionally apply to salespeople, whether or not their pitch is in an advert, written materials, or a one-on-one dialog.

Below one essential new rule, the salesperson should clarify how the brand new plan is completely different from an individual’s present medical insurance earlier than any modifications will be made.

That info may have helped an Indiana lady who misplaced protection for her prescribed drugs, which value greater than $2,000 a month, mentioned Shawn Swindell, the State Well being Insurance coverage Help Program supervisor of volunteers for 12 counties in east-central Indiana. A plan consultant enrolled the girl in a Medicare Benefit plan with out telling her it didn’t embrace drug protection as a result of the plan is geared towards veterans who can get drug protection by way of the Division of Veterans Affairs as an alternative of Medicare. The lady will not be a veteran, Swindell mentioned.

In New York, the Medicare Rights Heart acquired a criticism from a person who had needed to enroll only for a pay as you go debit card to buy nonprescription pharmacy objects, mentioned the group’s director of schooling, Emily Whicheloe. He didn’t know the salesperson would enroll him in a brand new Medicare Benefit plan that supplied the cardboard. Whicheloe undid the error by asking CMS to permit the person to return to his earlier Benefit plan.

Debit playing cards are amongst a dizzying array of additional nonmedical perks supplied by Medicare Benefit plans, together with transportation to medical appointments, home-delivered meals, and cash for utilities, groceries, and even pet provides. Final 12 months, plans supplied a mean of 23 further advantages, in keeping with CMS. However some insurers have advised the company solely a small share of sufferers use them, though precise utilization will not be reportable.

This month, CMS proposed further Benefit guidelines for 2025, together with one that may require insurers to inform their members about obtainable companies they haven’t used but. Reminders will “guarantee the massive federal funding of taxpayer {dollars} in these advantages is definitely making its method to beneficiaries and usually are not primarily used as a advertising and marketing ploy,” officers mentioned in a fact sheet.

Medicare Benefit members are normally locked into their plans for the 12 months, with uncommon exceptions, together with in the event that they transfer out of the service space or the plan goes out of enterprise. However two years in the past, CMS added an escape hatch: Folks can go away a plan they joined based mostly on deceptive or inaccurate info, or if they found promised advantages didn’t exist or they couldn’t see their suppliers. This exception additionally applies when unscrupulous plan representatives withhold info and enroll individuals in an Benefit coverage with out their consent.

One other new rule that ought to stop enrollments from going awry prohibits plans from touting advantages that aren’t obtainable the place the potential member lives. Empty guarantees have grow to be an growing supply of complaints from purchasers of Louisiana’s Senior Well being Insurance coverage Info Program, mentioned its state director, Vicki Dufrene. “They have been going to get all these bells and whistles, and when it comes all the way down to it, they don’t get all of the bells and whistles, however the salesperson went forward and enrolled them within the plan.”

So count on to see extra disclaimers in commercials and mailings like this unsolicited letter an Aetna Medicare Benefit plan despatched to a New York Metropolis lady: “Plan options and availability might range by service space,” reads one warning packed right into a half-page of effective print. “The formulary and/or pharmacy community might change at any time,” it continues, referring to the record of coated medicine. “You’ll obtain discover when essential.”

Nonetheless, the principles nonetheless permit insurers to boast about their rankings from CMS — 5 stars is the highest grade — though the rankings don’t replicate the efficiency of the precise plan talked about in an advert or displayed on the federal government’s Medicare plan finder website. “There isn’t any approach for shoppers to know the way precisely the star ranking displays the precise plan design, particular supplier community, or some other specifics of a selected plan of their county,” mentioned Laura Skopec, a senior researcher on the City Institute who just lately co-authored a study on the ranking system.

And since rankings knowledge will be greater than a 12 months previous and plans change yearly, rankings printed this 12 months don’t apply to 2024 plans that haven’t even begun but — regardless of claims on the contrary.

Learn how to spot deceptive Medicare Benefit and drug plan gross sales pitches (and what to do about it)

The Facilities for Medicare & Medicaid Providers has new guidelines cracking down on deceptive or inaccurate promoting and promotion of Medicare Benefit and drug plans. Be careful for pitches that:

  • Counsel advantages can be found to all who enroll when just some people qualify.
  • Point out advantages that aren’t obtainable within the service space the place they’re marketed (until unavoidable as a result of the media outlet covers a number of service areas).
  • Use superlatives like “most” or “finest” until claims are backed up by knowledge from the present or prior 12 months.
  • Declare unrealistic financial savings, comparable to $9,600 in drug financial savings, which apply solely in uncommon circumstances.
  • Market protection with out naming the plan.
  • Show the official Medicare title, membership card, or brand with out CMS approval.
  • Contact you when you’re an Benefit or drug plan member and also you advised that plan to not notify you about different medical insurance merchandise.
  • Fake to be from the government-run Medicare program, which doesn’t make unsolicited gross sales calls to beneficiaries.

For those who suppose an organization is violating the brand new guidelines, contact CMS at 800-MEDICARE, its 24-hour info hotline. For those who consider you selected a plan based mostly on inaccurate info and need to change plans, contact CMS or your State Well being Insurance coverage Help Program: or 877-839-2675. For extra details about defending your self from advertising and marketing violations, go to

November 30, 2023

KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working packages at KFF—an unbiased supply of well being coverage analysis, polling, and journalism. Be taught extra about KFF.


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