Unscrupulous marketing of Medicare Advantage create traps for the unwary

Medicare Advantage plans (also known as “MA plans” or “Medicare Part C”) are health plans for seniors offered by Medicare-approved companies that provide an alternative to traditional Medicare.

These are “bundled” plans that include Part A (hospital insurance), Part B (medical insurance), and typically prescription drug coverage (Part D).

The benefit of Medicare Advantage plans is that they may have lower out-of-pocket costs than regular Medicare and they may offer additional benefits that regular Medicare doesn’t cover, like vision, hearing and dental services. On the other hand, unlike original Medicare, many Medicare Advantage plans require you to see in-network providers and require a referral to see specialists.
But just as Medicare Advantage plans may be beneficial for certain seniors, they’re also highly profitable for health insurers that provide them. In recent years, this reality has caused unscrupulous companies selling private Medicare plans to engage in unseemly and sometimes fraudulent tactics to get patients enrolled.

For example, the New York Times reported this year that some marketing companies have posed as the Internal Revenue Service, the Social Security Administration and even Medicare itself, sending what looks like official forms to Medicare beneficiaries and demanding they fill them out and send them back. While it’s against the law for telemarketers to cold-call Medicare beneficiaries, once the recipient sends back the form, companies can call them repeatedly to pitch their plans.

Other marketers have provided fraudulent information. For example some TV commercials and mailings claim that switching to a Medicare Advantage plan will increase the recipient’s Social Security benefits by reducing their Medicare premiums. But at least one person who took the bait found out that his new plan didn’t cover prescription drugs and was hit with a devastating bill when he went to the drugstore.
Meanwhile, many such marketers are apparently directing their pitches at older people with cognitive impairments, including a 94-year-old Missouri woman with dementia who purchased a plan that didn’t include the hospital or doctors she saw in her rural area. In fact, some individuals have reported being switched from a traditional Medicare plan to a private Medicare Advantage plan — or from one private plan to another — without realizing it.

The Senate Finance Committee has been investigating these marketing practices, and Medicare itself has announced plans to police marketing materials and ads more carefully to ferret out potential fraud and abuse. But older Americans and their close relatives can’t rely entirely on government agencies to keep them safe from these scams. If you or a family member is a Medicare Advantage or traditional Medicare recipient, it’s a good idea to take the following steps:

  • Review your Medicare plan annually with an attorney
    Medicare open enrollment occurs each fall through early winter. This is when people can switch from original Medicare to Medicare Advantage or from Medicare Advantage to original Medicare or between Medicare Advantage plans. This is also when unscrupulous marketers intensify their targeting. Rather than risk falling prey, meet with an elder law attorney to discuss your existing coverage to determine whether it best meets your needs and to compare options to see what’s in your best interest. An attorney can help you figure out whether Medicare Advantage is for you.
  • Keep your personal information private
    Never reveal your Social Security or credit card numbers or personal health and financial information to anyone who is not part of your health care team. During the weeks before open enrollment, you may be bombarded with pitches, including from people claiming to be a Medicare sales representative. But there is no such job — Medicare officials only correspond with people by phone or email, and only in response to inquiries. So do not share your information with anyone who claims to be from Medicare. It is likely to be a scam.
  • Report suspicious behavior
    In addition to hanging up on suspicious phone callers and ignoring the doorbell when it’s someone you don’t know, be sure to report anyone you think is targeting you for fraud. You can report suspicious activity by calling 1-800-MEDICARE. An elder law attorney can also help you determine if something is suspicious and help you file a report.
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