Consumer Smarts: Beware private Medicare pitches

Seniors in Washington who want to purchase privately funded medical coverage have more than 70 Medicare Advantage plans to choose from, and they vary from county to county.

It's no wonder confusion abounds when deciding whether to switch to the private fee-for-service, run by private insurance companies, or stick to the original Medicare, a government-run health insurance program for those 65 and older.

In the midst of this, advocates warn that seniors may be taken advantage of, as aggressive sales tactics by insurance agents have been an ongoing problem nationwide.

Since 2006, the state Office of the Insurance Commissioner has received 300 consumer complaints about Medicare Advantage, sometimes known as Medicare Part C.

Some consumers said agents misled them or misrepresented themselves as government workers. Others complained about high-pressure sales tactics in homes or group settings or that they were enrolled in plans without their consent.

Q: How do I protect myself against deceptive or fraudulent sales tactics?

A: Don't be pressured into buying anything you don't fully understand. Read all the paperwork carefully, and check with your health care provider to ensure they participate in your plan before you switch.

Agents who sell medical coverage plans are not allowed to solicit door to door. They must be licensed with the state's Office of the Insurance Commissioner. Call the agency's consumer hot line, 800-562-6900, to make sure they're licensed and check on their complaint history.

If you enrolled in Medicare Advantage and want to leave your plan because you think you were misled, call 800-633-4227.

"Take the time to do research, and make sure the provider will accept the plan," said Stephanie Marquis, a spokeswoman with the Office of the Insurance Commissioner. The agency hasn't revoked licenses but has issued some letters of reprimand to agents, she added.

In Oklahoma, as well as other states, unlicensed agents were setting up shop in pharmacies, Wal-Marts and nursing home lobbies to "prey upon seniors' confusion and concern over their medical care coverage," that state's insurance commissioner, Kim Holland, told a Senate Committee on Aging this year.

Washington state Insurance Commissioner Mike Kreidler and others are pushing Congress to reform the Medicare Advantage program or get rid of it.

He and others want Congress to give states the authority over the plans because they say they're better equipped to protect consumers and investigate complaints.

"Unfortunately, we do not have authority over these plans," Marquis said. "We can offer advice to consumers, but official complaints must be turned over to the federal government."

In June, amid allegations of deceptive and aggressive marketing tactics, seven of the largest health insurers who offer private Medicare Advantage agreed to temporarily suspend marketing those plans to individuals. The seven insurers account for most of the Medicare Advantage market.

Abby Block, who directs the Centers for Medicare and Medicaid's Center for Beneficiary Choices, has said the voluntary moratorium will last until insurers can comply with guidelines that her agency released for 2008.

In Medicare Advantage, the private insurer -- not Medicare -- determines how much it will pay a health care provider and what you pay for the services you get. Make sure a physician, hospital and other providers accept the Medicare Advantage coverage before you enroll, otherwise you may be responsible for the full cost of services.

For help, see the state publication: goto.seattlepi.com/r916.

IF YOU THINK YOU WERE MISLED

The Centers for Medicare and Medicaid is allowing an exit strategy for those who enrolled in the private Medicare Advantage plan and want to leave because they were misled by sales agents or materials. Call 800-633-4227.