N.C. Commissioner Warns Seniors: ‘Beware of Aggressive Medicare Advantage Marketing’

North Carolina Insurance Commissioner Jim Long wants senior citizens to be aware of the aggressive marketing of Medicare Advantage plans by insurance companies and for seniors to be aware of what is legal and what resources they can turn to for advice. Some seniors are allegedly being advised to make decisions that may not be in their best financial interest, Long warns.

This warning comes after the Department of Insurance’s Seniors’ Health Insurance Information Program, or SHIIP, received an upsurge in calls from senior citizens, their family members and government agencies worried about the advice being given by companies offering Medicare Advantage products.

Recent Medicare reform laws have allowed more companies to sell these products, which are HMO, PPO or private-fee-for-service products. The influx of companies into North Carolina — and, more significantly, the surge in aggressive marketing of these products — has created many questions for Medicare recipients and those who care for them.

Complaints about these aggressive marketing tactics range from insurance agents soliciting seniors at discount stores to “cold calls” by agents wishing to set up appointments in seniors’ homes to pitch the product.

The complaints have included incidents of agents advising the seniors’ on financial decisions, such as canceling other insurance policies, which may not have been in the best interest of the client. While this type of marketing is not illegal, Commissioner Long and the staff at SHIIP are extremely concerned that this type of solicitation may lead seniors to make poor decisions that could affect their insurance coverage negatively.

Things that Medicare recipients should know about Medicare Advantage (also known as Medicare Health) plans:

• Medicare Advantage products ARE NOT Medicare supplement or Medigap plans. Medicare Advantage products are part of the Medicare program and will provide Medicare-covered benefits under Part A (hospital insurance) and Part B (medical insurance for doctor visits and other outpatient services) and sometimes extra benefits. There may be a monthly premium in addition to the Medicare Part B premium. The Medicare Advantage carrier will provide a health card that can be used at doctors’ offices, hospitals, etc. in place of your Medicare card.

• Representatives from companies offering Medicare Advantage plans may call you to schedule an appointment, but they can not come to your home without your permission. Before agreeing to an appointment, however, get the person’s name, which company he/she represents, and a phone number. Call the person back at that phone number in order to verify that he is who he says he is. Then make the appointment. If you have any doubts, call SHIIP at 1-800-443-9354.

• Make sure your doctors and/or hospitals or other medical providers accept the Medicare Advantage plan before you purchase it! If you buy a policy with Company X and then your regular doctor does not accept insurance from Company X, you have wasted your money and will have to pay all charges out of pocket.

• You may have out of pocket costs, such as co-payments for office visits, associated with the Medicare Advantage plan; be sure you fully understand the terms before you sign up.

• Some other health insurance plans, such as your employer plan that you have through retiree coverage, may not coordinate with the Medicare Advantage plan. Though a Medicare Advantage plan may cost less, it does not offer the same benefits.

• Do not be pressured into making quick decisions. This is a serious decision that should be considered carefully. Discuss it with a trusted family member or financial advisor before signing anything. Or, contact SHIIP for free counseling or to arrange for a counselor to visit with you in your hometown. SHIIP counselors are specifically trained to assist you with your health insurance questions. Call 1-800-443-9354.

“Above all, trust your instincts,” Commissioner Long said. “If it seems too good to be true, it usually is. Don’t give in to high pressure tactics, and don’t hesitate to call SHIIP with any questions you may have. We’re considered the model seniors’ health insurance information program in the nation, and we’re here to help.”

Topics North Carolina