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Industry Accepts More Oversight Of Medicare Advantage

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The nation’s health insurance industry today agreed to support federal legislation designed to curb the use of highly aggressive techniques in the marketing of Medicare Advantage plans.

The board of America’s Health Insurance Plans, which represents the industry, said it would also support adding provisions in the legislation giving state regulators greater oversight over the marketing of Medicare Advantage plans.

The AHIP board said it would accept provisions in legislation that would prohibit “cold calls” by agents and the offering of financial inducements to pressure seniors to listen to sales pitches.

The provisions were accepted in principle by the panel and will be incorporated into Medicare legislation currently being drafted, Sen. Max Baucus, D-Mont., announced after the meeting.

He expects to bring Medicare legislation forward for consideration this spring.

The AHIP board issued a statement before the meeting that said its proposal indicating “its strong commitment to serving seniors in Medicare and to advocate that more be done through this process to advance consumer protections.”

AHIP directors say they will also support provisions requiring Medicare Advantage and Part D plans to comply with state information requests about the performance of a licensed agent or broker as part of a state investigation into the individual’s conduct.

On state regulation, the board said in the meeting with the Senate Finance Committee that it would recommend that states be given additional tools to monitor sales activities and address market-conduct issues.

At the same time, Baucus said his bill would include language on marketing curbs beyond those suggested by the AHIP board.

In addition to prohibitions on cold calls, door-to-door marketing and financial inducements for seniors, AHIP’s proposals included better training of sales agents, stronger oversight at the local level and other measures.

Baucus said additional provisions that he will include in his legislation to protect seniors include:

A prohibition on agents suggesting home visits to seniors. Home visits should be allowed only if seniors expressly request them, he said.

A prohibition on gifts or meals used to entice seniors to listen to sales presentations.

Oversight authority to monitor and enforce senior protections at the state level to compensate for a lack of oversight by the Centers for Medicare and Medicaid Services

In the meeting, Baucus also reiterated his concern about private Medicare Advantage providers that tie their agents’ bonus and compensation to the total number of approved applications, rather than to ensuring that consumers have the appropriate plan and coverage.


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