Adieu, Medicare Advantage?

Another insurer gets in trouble

A week or so ago, the Centers for Medicare and Medicaid Services (CMS) ordered WellCare, the super-aggressive seller of Medicare Advantage plans, to stop selling policies to seniors beginning March 7 until they cleaned up their act and improved their business practices. That hurts the company right now, since seniors have until the end of the month to switch to a different Advantage plan, and the marketing from the competition has been hot and heavy. About one in three seniors who enroll in Medicare’s drug benefit now choose these plans over traditional Medicare because of their low premiums and extra benefits.

CMS said that WellCare had “demonstrated numerous deficiencies in serving its enrollees.” There were problems with enrollment and disenrollment procedures, appeals and grievances, oversight of its marketing agents and brokers, and responding to consumer requests for help and complaint resolution. From the beginning of January to the beginning of February this year, CMS said the agency received more than 2,500 complaints from seniors with WellCare policies. Almost 800 of those were considered “immediate need” complaints, which means they were supposed to be resolved within two calendar days. CMS said that the carrier had failed to resolve about 300 of these complaints within the required time frame.

The CMS action is notable for two reasons:

First: Few press outlets picked up the WellCare story, which might have been of great interest to seniors—who, yes, still read newspapers. CMS spokesman Peter Ashkenaz admitted the agency didn’t widely promote it. These days, if an agency has some important announcement, it’s best to circulate it far and wide given the decimated news gathering staffs at so many media organizations. Bloomberg published the story, reporting that, according to CMS, WellCare used forged enrollment applications and gave buyers misleading or inaccurate information.

Florida Health News, a foundation-supported, independent online news service, also did a story. In early February, the service revealed more about sellers’ marketing practices. It reported that some Medicare Advantage sellers (though not WellCare) were paying brokers as much as $500 for each potential Medicare Advantage customer sent their way. That’s a pretty hefty fee. The story named Coventry and Care Plus, a Humana subsidiary.

Second: WellCare is the second company since the beginning of the year that has had to curtail its marketing activities. In January, CMS ordered insurance giant WellPoint to stop marketing Medicare Part D (drug benefit) plans because, it said, the carrier had denied thousands of beneficiaries access to critical medications.

This hasn’t been a particularly friendly time for Medicare Advantage plans. The Obama budget contemplates cutting the overpayments to the plans and making sellers compete on an equal footing with sellers of other Medicare insurance products. It costs the federal government about 14 percent more on average to provide benefits to seniors who choose to get them from Medicare Advantage plans than it does to provide the benefits directly under the Medicare program. Those overpayments allow sellers to offer gym memberships, lower premiums, and other goodies. But as one reader of Campaign Desk pointed out, there are often hidden charges that don’t surface until illness strikes. The Obama administration is eyeing the pot of money—some $175 billion over 10 years—that could be used for other purposes, like increasing fees to doctors, who are scheduled for a 21 percent fee cut in 2010.

Shoddy sales practices; questionable quality control; a government crackdown on insurers, including one of the country’s largest; big, big money involved; doctors escaping wallet pain; insurers fighting doctors over taxpayer dollars; the rising number of financially strapped seniors flocking to Medicare Advantage plans and taking a risk—a lot is at stake. To us, it seems like a dramatic story unfolding, and one where the public interest is huge. Whether the stories are done in short takes or as in-depth reports, whether in new media or in print, they need to be told.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.