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Regulators target Medicare Advantage sales practices

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If you sell Medicare Advantage plans or advise clients about buying them, watch out. That’s because regulators and lawmakers are zeroing in on abusive sales practices and even considering supplementing federal oversight of the market with a limited grant of authority to states.

This comes in the wake of ongoing media coverage about alleged abusive sales practices with Medicare Advantage fee-for-service plans. A May 2007 New York Times article cited cases where agents used hard-sell tactics to pressure seniors into buying these products, even going so far as switching them out of traditional Medicare without their permission.

Although Medicare and Medicaid announced new regulations to curb alleged abusive sales practices, there remains widespread concern that states need greater authority to protect consumers. This has led to pending legislation in the U.S. Senate – the Accountability and Transparency in Medicare Marketing Act of 2007.

In this environment, agents must never engage in the following sales practices:

  • Pressuring beneficiaries to enroll in unsuitable or inappropriate plans.
  • Enrolling beneficiaries without them fully understanding it will lead to loss of traditional Medicare and Medigap coverage.
  • Misleading seniors about Medicare Advantage’s provider network or provider reimbursement policies.
  • Mishandling enrollment applications.
  • Not informing (or misleading) seniors about a plan’s cost-sharing features.
  • Using Medicare Part D (coverage for prescription drugs) to pressure a senior to buy Medicare Advantage or life insurance coverage.?


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