Private health plans criticized

The insurance agent who met Justine Ackerman at the Mid-City Senior Center told her to call any time.

But after the 94-year-old Spokane woman signed up for the Medicare Advantage plan he was pitching, she said the Spokane Community Care broker never answered his phone.

“I just wanted them to cancel it,” said Ackerman, who learned too late that the new health plan didn’t suit her needs. It didn’t cover her doctor, for one thing, and it enrolled her in a prescription drug plan that charged more than the price of her pills.

“I think they shouldn’t come in here,” said Ackerman, who plays bingo at the senior center. “They talked us old people into doing things we don’t want to do.”

And Ackerman is not alone.

The widowed great-grandmother is among dozens of elderly residents in the Inland Northwest who say they were duped into signing up for Medicare health insurance plans offered through private vendors.

Washington state Insurance Commissioner Mike Kriedler announced Tuesday that he has fielded more than 300 complaints in the past year from consumers and their advocates who say they were unfairly sold Medicare Advantage plans that in some cases cost more and provided fewer services than clients already had.

One Spokane agent received a letter of reprimand and two others received letters warning them about their marketing practices, insurance officials said.

In North Idaho, at least 25 complaints have been logged with the Statewide Health Insurance Benefit Advisors – SHIBA – offices since January, said Jason Hobson, a coordinator in the Coeur d’Alene office.

“People are saying they were enrolled in the plans and they didn’t really understand what they were getting into,” Hobson said. “In some cases, it has caused real problems.”

Kriedler called for limits on the more than 70 Medicare Advantage plans available in Washington and for the federal government to turn monitoring of the programs over to the states.

Across Washington and Idaho, complaints have focused on problems that range from inaccurate information and pushy marketing techniques to outright fraud. Agents are accused of enrolling clients in plans that excluded doctors and hospitals, tacked on expensive co-payments or offered unneeded services.

Others may have misrepresented themselves as government workers, enrolled clients without consent or lied about the future of the federal medical insurance program.

“There were some particularly egregious cases of people being told that Medicare was going away,” said Tobi Johnson, director of the SHIBA program in Washington.

In many cases, it appears that agents, who were paid for each client they enrolled, were simply trying to boost their income, Hobson said.

“Once they get their commission, they couldn’t care less,” he said.

But an executive for Arcadian Health Plan Inc., the insurance company that does business as Spokane Community Care, disagreed. Agents aren’t paid for clients who revoke enrollment within 90 days of signing up, noted President Nancy Freeman. And she said Medicare Advantage plans offer valuable choice in a crowded health care market.

“We feel like we can guarantee access, as well as keep our co-payments low,” she said Tuesday.

Freeman said company representatives contacted Justine Ackerman after receiving notice in April that a complaint had been filed with the insurance commissioner’s office. Ackerman didn’t recall filing a complaint, Freeman said.

She acknowledged that some seniors may be confused by the wide array of health insurance choices available, especially in the wake of federal Medicare Part D prescription drug program.

“We encourage them to have an advocate or family member to help them interpret what they are seeing before they sign,” Freeman said.

She added that she had no record that agent Dale Anderson had failed to return Ackerman’s calls.

Complaints about Medicare Advantage plans have drawn national as well as regional attention. Between December 2006 and April 2007, more than 2,700 agent complaints were lodged against the private fee-for-service plans that have proliferated in recent years.

Those complaints represented a fraction of the 1.3 million members who have signed up for plans, noted Michael Marchand, spokesman for the Northwest region of the Centers for Medicare and Medicaid Services. But, he added, those are 2,700 complaints too many.

“While most agents are helpful and responsible, there are some bad actors that need to be removed,” Marchand said Tuesday.

Last month, CMS announced that seven companies that operate more than 90 percent of those plans had agreed voluntarily to suspend their marketing practices until they could prove they met federal guidelines.

That’s not good enough, according to a state advocacy group’s new report, released Tuesday in conjunction with Kreidler’s announcement. Washington CAN! said Medicare Advantage plans amount to incremental privatization of Medicare and that they cost the government – and clients – more money than the traditional government health care plan.

Figures released recently by the non-partisan Medicare Payment Advisory Commission estimate that Medicare Advantage plans are paid, on average, 12 percent more per person than similar services through traditional Medicare, and that the fee-for-service plans are paid an average of 19 percent more. In Washington, that amounts to $1,503 per enrollee, or a total of $233 million a year, according to the group.

Advocates called for Congress to end subsidies of Medicare Advantage plans and spend the savings on health care for low-income children, seniors and people with disabilities.

Changing Medicare Advantage reimbursements or regulations would require a legislative overhaul, Marchand said.

In the meantime, seniors like Justine Ackerman should be leery of changing their Medicare providers, said Leslie Noll, Medicare specialist with Aging and Long-term Care of Eastern Washington. She’s especially concerned about insurance agents who may target low-income housing developments or senior centers.

“These people are just preying on them,” she said.