Beware of Insurance Agents Giving Misleading Information on Cal MediConnect

Beware of Insurance Agents Giving Misleading Information on Cal MediConnect

Sacramento, CA— We recently received several reports about insurance company agents who are visiting senior apartment complexes and giving out false information. According to reports, these agents are scaring people, telling them that come fall they will not be able to see their regular providers anymore unless they sign up for a plan from the agent’s company.

For example, one agent walked right into an elder’s apartment, startling him with her abrupt, uninvited entry. She proceeded to give him inaccurate information that he would lose his doctor due to Medicare changes this fall, and claimed that her company’s plan would be a much better fit for him. Another agent at a low-income senior housing complex was encouraging beneficiaries to sign up for her company’s plan by offering a “coupon” of $50 off their medication for those who enrolled.

Sorting fact from fiction about Cal MediConnect It is not true that people will no longer be able to see their regular doctors this fall. Agents who are scaring seniors with this false information may be doing so deliberately to secure an enrollment commission or may have a misunderstanding about a new demonstration called Cal MediConnect.

Cal MediConnect is slated to begin no earlier than January 1, 2014 in 8 selected counties: Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara. The goal of Cal MediConnect is to integrate Medicare and Medi-Cal benefits for individuals eligible for both programs, commonly called duals or Medi-Medis. Not all Medi-Medis are eligible for Cal MediConnect. Those who are may choose a Cal MediConnect plan, opt out for their Medicare benefits, or be passively enrolled by the state into a Cal MediConnect plan. In any case, duals will be able to continue to see their current providers for a limited time even if their providers are not in the network of the Cal MediConnect plan.

By telling seniors that they will no longer be able to see their doctor, these agents are not only giving wrong information, they are scaring seniors into a plan that may not be appropriate for them. There are many factors to consider before deciding on a plan. Access to one’s doctors is only one consideration; others include coverage and quality. Regardless of whether a plan is appropriate for a senior, the agent earns a commission for enrolling a new member.

What you can do As with any major change, there is confusion, which creates a situation ripe for fraud scams and marketing abuses. We urge Medicare beneficiaries to consider seriously whether a plan meets their needs before saying “yes” or signing anything. They should not be pressured into signing up with a plan, nor enroll because of a scare that they can no longer see their doctor.

If you or someone you know hears of such misinformation or marketing abuses, please collect as much information as possible (agent’s name, phone number, company s/he represents, etc) and report the incident to our Senior Medicare Patrol office at 855-613-7080. You can also visit SMP’s website at: www.cahealthadvocates.org/fraud-abuse/.

In addition, see calduals.org for more information on Cal MediConnect or call your local Health Insurance Counseling and Advocacy Program (HICAP) at 800-434-0222.

The California SMP program was awarded to California Health Advocates in 1997 when the SMP program was first established by federal law. California Health Advocates is an independent non-profit organization that provides quality Medicare and related health care coverage information, education and policy advocacy. SMP volunteers are available in each county through the Health Insurance Counseling and Advocacy Program (HICAP), which provides benefits counseling and community education directly to those with Medicare and their families. For more information on CHA, SMP and HICAP, visit CHA’s website at cahealthadvocates.org.

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Contact:

Julie Schoen
SMP Project Director
California Health Advocates
(714) 560-0309
jschoen@cahealthadvocates.org

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.

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