An increasing number of cases have been reported to the Health Insurance Counseling & Advocacy Program (HICAP) of beneficiaries finding themselves enrolled in a MA or Part D plan that differs from what they thought they enrolled in. The common threads of these situations are the ambiguous and misleading marketing tactics of certain sales representatives. For example, in April, California Health Advocates’ Community Outreach Coordinator, Marta Erismann, conducted a Senior Medicare Patrol (SMP) training in Eureka for the Humboldt/Del Norte HICAP, Area 1 Agency on Aging. During the presentation, Anne Antoville, the HICAP Program Manager for that area, and several volunteers expressed concern about the marketing strategies of a large MA plan and the specific behavior of the plan’s representatives in their area. Beneficiaries were calling HICAP claiming: to have been enrolled without their knowledge into the company’s Medicare Advantage (MA) plan when an agent said they would be enrolled into that company’s stand-alone prescription drug plan (PDP); and to have been erroneously sold the company’s MA plan when they thought they were buying a Medigap policy. Other beneficiaries claimed that the agent did not explain to them that enrolling into a MA plan would replace their original Medicare. And finally many beneficiaries did not receive enrollment paperwork from the MA plan’s representative.
To address these expressed concerns, California Health Advocates has filed a complaint with the Department of Insurance on behalf of the Eureka-Del Norte HICAP and ten of the sixteen HICAP clients who wanted to make a formal complaint. The complaint provides details of the allegations against an agent licensed by the California Department of Insurance, and cites the various provisions of the California Insurance Code that may have been violated. The complaint also provides helpful information and citations regarding Part D Medicare Advantage plans and the Private Fee for Service Plans in particular to help department personnel understand how and why the actions of the agent were detrimental to these beneficiaries. While federal law preempts state law in regard to MA plans in California, agents who sell these plans do so as a licensed agent and are required to comply with all state laws for licensed agents.
A second complaint has been drafted on behalf of the Fresno HICAP and 33 of their dually eligible clients, whose primary language is Spanish. This complaint concerns the activities of an agent who switched the coverage of these beneficiaries to the MA plan he was selling.
California Health Advocates’ SMP program and the HICAP network are happy to assist with any complaints regarding the inappropriate sale of an MA plan. People with a complaint can email Bonnie Burns, California Health Advocates Training and Policy Specialist, firstname.lastname@example.org , or call Anne Gray, SMP Program Coordinator at 714-560-0309. These complaints are collected for advocacy efforts with key decision makers and media contacts. Complaints can also be submitted in confidentiality and/or anonymity.