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.
I switched to WellCare for drug insurance starting in January because they were inexpensive. No problems so far. Who do I contact if there is a problem?
#1 Posted by Jay Workman, CJR on Mon 2 Mar 2009 at 02:08 PM
The first place to start is with the plan itself. If the plan doesn't respond or does not resolve the problem within 48 hours, that's what CMS says is an "immediate need complaint." Then it's time to contact CMS by calling 800-633-4227 or 800-MEDICARE. If you call the Medicare number before first going to the plan, Medicare will just refer you back to the plan.
#2 Posted by trudy lieberman, CJR on Mon 2 Mar 2009 at 05:04 PM
Good article. Alas, the link to "But as one reader of Campaign Desk pointed out, there are often hidden charges..." is not working. It is very difficult to find authentic online information regarding specific hazards of Advantage plans for the potential user.
#3 Posted by JoAnn Clevenger, CJR on Tue 3 Mar 2009 at 12:04 PM
Go to the web site of the California Health Advocates. That group, which counsels Medicare beneficiaries in California about their options, has some reports on Medicare Advantage plans that should be helpful.
#4 Posted by Trudy Lieberman, CJR on Tue 3 Mar 2009 at 03:02 PM
Doctors don't see any extra money for taking care of Medicare Advantage patients but hospitals do...expect some lobby support from Hospital Associations for the Payors who push Medicare Advantage. These Payors don't keep all that extra money for themselves, they sprinkle it around.
#5 Posted by Doc4Change, CJR on Wed 4 Mar 2009 at 09:53 AM
As usual, a few bad apples are spoiling the bunch - 100% commission agents don't get paid unless they sell, so they'll say ANYTHING, and use misleading tactics or high pressure - then the whole company gets in trouble.
I've been on WellCare for 2 years now, and they've been WONDERFUL. I think a lot of people get the plans,then forget all about how it's SUPPOSED to work, whether explained well to them or not, and start griping about getting 'mislead' because they don't want to take responsibility for being older and forgetting.
And CMS just doesn't like their phones to ring. So when people call about ANY insurance, they get pissed, and this is what happens.
#6 Posted by Donald, CJR on Wed 4 Mar 2009 at 05:18 PM
My husband and I have had Medicare Advantage plans with Humana for the last three years and have been very happy with our change - the coverage is identical to that which he paid for out-of-pocket to his civil pension board for our benefits. Any problems we've had have been hospital-generated (review board) rather than insurance-generated. We both have had surgeries during this time (cataract and knee replacement) and our costs were reasonable. There are other plans which charge decent monthly fees which will keep medical expenses lower when they are necessary - probably a better deal if your health issues are worse. than ours. Having said that, I would also like to point out that insurance companies get the blame for problems with health care but it's a much more complex problem than that and things really got out of control when the government got involve in health care in the 80's. Beware of more involvement by this administration: what the government gives, the government also takes away from someone else.
#7 Posted by MaryEllen Lempa, CJR on Thu 5 Mar 2009 at 12:07 PM
Everybody wants something for nothing and the insurance plans are only too happy to "provide healthcare" or ration payments for their 15-20%. It isn't healthcare that's in trouble, it's health insurance. The demographic free ride for seniors is over.
#8 Posted by Harleys R. Toofuknloud, CJR on Mon 9 Mar 2009 at 12:34 PM
I really enjoyed your article regarding the future of Medicare Advantage. Would it be possible to get permission to reprint portions of it?
#9 Posted by Karen Lingar, CJR on Mon 9 Mar 2009 at 05:09 PM
Karen,
Thank you. On the reprint request, just e-mail us and tell us where/when etc., and we'll be happy to help. Mike Hoyt/editor
mike.hoyt@cjr.org
#10 Posted by mike hoyt, CJR on Tue 10 Mar 2009 at 08:40 AM
I recently joined Well Care part D prescription drug plan but am thinking about joining the advantage plan. I reviewed the Humana plan (mostly to check out dental benefits) but Humana states their dental benefit is a "discount" on services. Is a discount for dental services the best any of these advantage plans have to offer?
#11 Posted by linda, CJR on Thu 12 Mar 2009 at 05:39 AM
Has anyone heard any rumors regarding when California insurance companies will begin to offer Medicare Advantage plans again? Thanks
#12 Posted by Pete3, CJR on Sun 22 Mar 2009 at 09:15 PM
December 2011 : Sr care Advantage has found a new way to seem to offer insurance but in fact is refusing it : seniors are usually plagued with chronic problems which require some kind of therapy. Personally I have arthritis and lymphedema which requires two kinds of therapy, water exercise and lymphedema therapy both of which require at least once per week, preferably more than once per week. This is still below the standard in Europe ! The copay for therapy is the same as for a specialist doctol which is $35/visit. You can easily add this up to see that if I have one session per week of each therapy the cost is about $300/mo, more than if I had to be hospitalized for an acute episode of something. What this adds up to is that the senior can afford to see his PMD with a copay of$15 but cannot comply with the treatment because of the expense.
#13 Posted by Rae A Pearcy, CJR on Tue 20 Dec 2011 at 11:33 AM