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Industry Says Times Article On Medicare Advantage Is Off-Base

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The health insurance industry is contending that a newspaper article published last week detailing examples of hard-sell tactics used to sell Medicare Advantage programs involves only a few “bad apples.”

“It is important to note 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,” said Kelly Loussedes, a vice president at the National Association of Health Underwriters, Arlington, Va.

She was commenting on a May 7 article in The New York Times citing cases where agents for Medicare Advantage plans have been charged with using hard-sell tactics to pressure elderly Americans into signing up for policies that the Times alleged “may leave them worse off than they would be with traditional Medicare coverage.”

The Times article charged that the “abusive sales tactics are particularly egregious among private fee-for-service plans,” which it said are the fastest-growing type of private Medicare coverage.

The article said state officials are investigating a range of sales abuses, including a case in Georgia where 2 insurance agents were arrested and accused of signing up unwilling consumers. In the story, one beneficiary said her signature was forged by a door-to-door salesman.

In North Carolina, the article said, the insurance commissioner is investigating complaints that agents switched residents of an assisted-living facility from traditional Medicare into private plans without their permission. At least 5 other states are investigating complaints about sales tactics, the article said.

In response, Loussedes and Mohit Ghose, a vice president at America’s Health Insurance Plans, Washington, D.C., said members of the 2 groups are working with Centers for Medicare and Medicaid Services to develop and offer training programs for brokers and agents.

The 4-part education program deals with Medicare, Medicare Part D, Medicare Advantage, and the rules and responsibilities of each program.

“The course, like all NAHU programs, teaches and encourages ethical professionalism,” Loussedes said. “This continuing education has been approved in almost 40 states, and so far hundreds of NAHU members have participated in the education courses.”

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

Additionally, Ghose said, Medicare Advantage plans 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 telephone calls to new members, monitoring agent calls to beneficiaries and monitoring complaints, Ghose said.

“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,” he added.

Loussedes said, “Professional health insurance producers like our members are bound by a strict code of ethics that states they must ‘respect my clients’ trust in me and never do anything to betray that trust or confidence.’”

She added, “NAHU members are of the highest caliber; therefore, it is unfair to label all agents selling Medicare Advantage Plans as dishonest because of the outrageous behavior of a few unethical individuals.”

She said it is “not surprising that seniors with no supplemental coverage on a fixed income find these plans particularly attractive, and that’s why sales have increased over the past year.”


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