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The Palm Beach Post's veteran Washington correspondent, Larry Lipman, tracks policy makers and interest groups who are shaping the future of the federal health insurance program for the elderly.Medicare Web Resources
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Medicare is the federal health care system that covers about 36 million people age 65 and older, plus 7 million disabled. It has four parts:
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Financed by Medicare and beneficiary premiums, which vary among plans.
The plans are private and financed by Medicare and beneficiary premiums, which vary among plans.
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Home > Medicare Monitor > Archives > 2008 > May > 08 > Entry
Medicare announces new protections
Medicare announced a series of new changes to crack down on high-pressure Medicare Advantage sales techniques and to make it easier for low-income beneficiaries to obtain benefits.
“The Medicare Advantage program is a valuable source of enhanced benefits and coordinated care for beneficiaries, and it should not be undermined by the actions of a limited number of unscrupulous sales agents,” said Kerry Weems, acting administrator of the Center for Medicare and Medicaid Services.
According to Medicare, the proposed marketing standards for Medicare Advantage (MA) plans would:
- Prohibit cold-calling and expand the current prohibition on door-to-door solicitation to cover other unsolicited circumstances. Any appointment with a beneficiary to market health care-related products would have to be limited to the scope that the beneficiary agreed to in advance. Cross-selling of non-health care-related products to a prospective MA or Part D enrollee would also be prohibited.
- Prohibit sales activities at educational events such as health information fairs and community meetings or in areas such as waiting rooms where patients primarily intend to receive health care-related services, as well as limit the value and type of promotional items offered to potential enrollees.
- Require that MA organizations that use independent agents to market MA and Part D plans use state-licensed agents for such marketing, and require that MA organizations report to States, in a manner consistent with State appointment laws, that they are using those agents.
- Require MA organizations to establish commission structures for sales agents and brokers that are level across all years and across all MA plan product types (for example, HMOs, PPOs, and private fee-for-service plans). Commission structures for prescription drug plans would have to be level across the sponsors’ plans as well. These requirements are designed to discourage “churning” of beneficiaries from plan to plan each year in a manner that earns agents and brokers the highest commissions and would ensure that beneficiaries are receiving the information and counseling necessary to select the best plan based on their needs.
To make it easier to qualify for low income drug assistance, Medicare would use a more lenient “best available evidence” process.
Medicare also would forbid Part D plans from disenrolling beneficiaries who had chosen to have their premiums withheld but, for whatever reason, those premiums were not deducted.
The proposals also give Medicare stronger authority to levy fines of up to $25,000 per enrollee against Medicare Advantage plans to violate Medicare rules.
Comments
By Helen
May 8, 2008 4:17 PM | Link to this
Praise the Lord that CMS is going to do something about these SCAM AGENTS that churn these poor Medicare Beneficiaries. I sale MA plans and it all comes back ten-fold to one if you do what is right and what is best for these Seniors. Thanks and I hope CMS is diligent in getting these issues in force and truly do have a Watch Dog to oversee some of these unscrupulous agents we see in all markets.