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Industry Responds To Times Medicare FFS Article

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Health insurance industry representatives say a recent New York Times account of aggressive Medicare Advantage marketing tactics describes the activities of a few bad apples.

“The vast majority of health insurance producers work very hard to find quality and appropriate health coverage at the best possible price for millions of employers, individuals and families every day,” says Kelly Loussedes, a vice president at the National Association of Health Underwriters, Arlington, Va.

“It is unfair to label all agents selling Medicare Advantage plans as dishonest because of the outrageous behavior of a few unethical individuals,” Loussedes says.

The Medicare Advantage program is best known for offering older Americans and disabled Americans access to health maintenance organization plan options from private carriers, and it also has added access to private preferred provider plan and private fee-for-service plan options.

The Times article, which ran on the front page of the newspaper May 7, says at least 6 states are investigating reports of agents pressuring elderly Americans into buying unsuitable Medicare Advantage policies.

The “abusive sales tactics are particularly egregious” in the Medicare Advantage private FFS plan market, the Times reports.

The Medicare Advantage program is growing because the extra benefits program plans provide are very attractive to seniors living on fixed incomes, Loussedes says.

Loussedes and Mohit Ghose, a vice president at America’s Health Insurance Plans, Washington, says their groups have worked with Centers for Medicare and Medicaid Services to address concerns about Medicare plan marketing by developing a 4-part training program for brokers and agents.

The training program covers the rules and responsibilities associated with selling Medicare Advantage plans and Medicare Part D prescription drug plans.

The course has been approved for continuing education credits in more than 30 states, and hundreds of NAHU members have taken the course, Loussedes says.

“The course, like all NAHU programs, teaches and encourages ethical professionalism,” Loussedes says.

AHIP members have established certification requirements that agents and brokers must meet before becoming qualified to market the sponsor’s Medicare Advantage plan, and many have compensation arrangements that include incentives that discourage inappropriate marketing practices, Ghose says.

In addition, Ghose says, Medicare Advantage plan sponsors use a variety of mechanisms to monitor agent and broker performance and compliance with CMS marketing guidelines and “take quick action to address inappropriate behavior, including termination of contracts.”

Other oversight activities include making telephone calls to new members, monitoring agent calls to beneficiaries, and monitoring complaints, Ghose says.

“We will continue to work with CMS to ensure that Medicare beneficiaries are able to make the health care coverage decision that suits them best,” Ghose says.


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