番茄社区

Last week, CMS administrator Chiquita Brooks-LaSure was in South Dakota listening to Native American tribal members explain how they were persuaded to enroll in Medicare Advantage (MA) plans whose networks -- they subsequently realized -- didn't include their local Indian Health Service providers.

"I hear regularly from patients and doctors when they have to delay their care, including significant procedures like surgeries, due to prior authorization or other rules" in MA plans, she said. "And [beneficiaries] may not have the understanding of the steps that they're going to have to take when they sign up for a Medicare Advantage plan."

While visiting a Michigan adult day center last year, she heard from seniors who were "being bombarded with phone calls" from MA sales representatives who confused them. The seniors all had questions but they didn't know who they could trust, she said.

Brooks-LaSure made her remarks during a Kaiser Family Foundation Wednesday that focused on misleading and deceptive MA plan marketing strategies that used celebrity actors or sports icons making exaggerated or false benefit claims on TV -- all to woo senior beneficiaries to sign up.

Things are going to be different with this year's ad campaigns before and during the annual Medicare re-enrollment period Oct. 15 through Dec. 7, she said. That's because ads like last year's are going to be strictly curtailed under new in which CMS must pre-approve all television MA plan advertising. Complaints to the agency about misleading agent and advertising practices are now not only strongly encouraged, but CMS has beefed up its ability to investigate them, she said.

And there are new protections that guard against "predatory behavior to ensure that people with Medicare are not pressured into enrolling" in an MA plan, Brooks-LaSure said. For example, now, people who attend Medicare educational events cannot be subject to MA sales pitches right afterwards. Agents must also explain any impacts the change under discussion will have on a person's current coverage, something they previously weren't required to do.

She gave numerous other examples of ways CMS rules will limit marketing deception. Sellers must now disclose which plans they represent, and that they don't represent all area plans if they don't. They also can't use logos resembling Medicare, "so ads that mislead people into believing they are from the government are prohibited," Brooks-LaSure said.

The webinar was held in part to publicize a KFF released Wednesday that reviewed 1,200 unique ads -- mostly for MA plans -- that aired during last year's 9-week re-enrollment window.

The KFF researchers documented that among 650,000 airings, 27% potentially misled beneficiaries into thinking they were being recruited for traditional Medicare because the ads portrayed images of a government-issued Medicare card. Some 16% urged viewers to call a "Medicare" hotline, which was a line for the plan or its agents, rather than the official 1-800 Medicare hotline, the report said.

The KFF report noted that many of last year's ads just depicted seniors looking healthy and active, such as playing tennis, mountain biking, or jumping on trampolines. "Few ads showed people with visible disabilities (4%) or the appearance of serious illness (1%) though one-fifth of Medicare beneficiaries are in fair or poor self-reported health," the report said.

Instead of conveying benefits for people with serious health conditions, many of the ads pitched offers of massage therapy or spending cards for groceries or rent, or money back in your social security checks, the report and its authors said.

"Benefits that may appeal to people in poorer health, and those that are valuable to people with serious illnesses or mobility impairments are marketed substantially less often," Jeannie Fuglesten Biniek, KFF's associate director of Medicare Policy and one of the report's authors, said during the webinar.

She said that KFF conducted focus groups and discovered many beneficiaries were confused about their coverage options, didn't know what they were trading off, and that it was difficult to compare MA plans.

The MA plan pitches featured celebrities such as Joe Namath, Lionel Richie, William Shatner, and JJ Walker, who urged seniors to "Get what you deserve!"

Webinar panelist Lindsey Copeland, director of federal policy for the non-profit Medicare Rights Center, which helps beneficiaries navigate the system, said their clients feel as if marketing materials and TV ads pressured them to sign up, even if they're perfectly happy with their current coverage. Some ads repeatedly admonished beneficiaries that they're missing out on important benefits, or implied "they're not complying with official Medicare rules or deadlines."

"Alarmingly, about 20% of our helpline calls on misleading marketing are from people who were enrolled in a plan without their knowledge or consent," Copeland said. One client just thought he was answering a caller's questions about Medicare and didn't realize he was actually being enrolled in an MA plan until he got the paperwork.

"The folks with 12 PhDs will probably find their way through these ads and find what's best for them, but not everyone will," KFF President and CEO Drew Altman said, speaking of last year's ads, some of which he described as having a "cheesiness" to them.

Webinar panelist Mark Hamelburg, representing AHIP (formerly America's Health Insurance Plans) agreed that the new CMS restrictions are important to protect beneficiaries from "bad actors," and will really change the marketing environment going forward.

But he defended MA plans in general, which now enroll 31.5 million people, saying they are "really working remarkably well," because if they weren't, "seniors would not be signing up. They would be leaving in droves." They can always go back to traditional Medicare, he said.

Copeland emphasized that MA ads need to make it clear to beneficiaries who switch that they will have network limitations, and when they need certain procedures, they will have to wait for prior authorization.

"Many were promised things that failed to materialize, you know, extra benefits, lower part B premiums, maybe robust provider networks," Copeland said. It's especially complicated for people with Original Medicare and supplemental coverage, like a Medigap, because "if you give that up, you might not be able to get it back" because most states allow supplemental plans to reject people with health issues.

"Caveat emptor is a pretty wild position to take when you're talking about older adults and people with disabilities and their health insurance," she said.

Webinar panelist Christopher Graves, president and founder of the Ogilvy Center for Behavioral Science, noted that not all of the problematic ads are selling MA plans. Rather, some are designed only to generate leads. They get the beneficiary "to pick up the phone and call and share some of your contact details. Why? They resell those contact details ... to capture your data. And it hasn't been clear to the consumers which is which."

In her remarks, Brooks-LaSure emphasized that the agency is not concerned that people are enrolling in MA plans, only that they have complete and accurate information about what they're getting when they do.

Comment