Medicare Advantage, scams, elder woman concerned, looking at phone

Medicare Advantage Advertisement Complaints & Enrollment Abuses on the Rise

In early November, the Senate Finance Committee Chairman Ron Wyden, D-Ore released a report documenting the substantial rise in agent/broker marketing fraud and enrollment abuses for Medicare Advantage plans. The report calls for significant action from the Centers for Medicare and Medicaid Services (CMS) to halt this trend and protect our country’s Medicare beneficiaries.

The Senate Finance Committee Majority Staff launched an inquiry in August, collecting information from several states and finding a common trend of beneficiaries being inundated with aggressive marketing tactics as well as false and misleading information. CMS’ complaint data mirrors this trend showing that the number of Medicare beneficiary complaints about private sector marketing for Medicare Advantage plans more than doubled from 2020 to 2021.

Wyden’s report exposes numerous tactics used by insurance companies, brokers, and third party marketers to push seniors to sign up for their plans, including deceptive mail advertisements, misleading claims about increasing Social Security benefits, aggressive in-person marketing tactics, and enrolling beneficiaries, particularly those dually eligible for Medicare and Medicaid, in a new plan without their consent.

Some real-life scenarios/case studies in the report, and summarized in a recent news article include:

  • Seniors shopping at their local grocery store were approached by insurance agents and asked to switch their Medicare coverage or MA plan.
  • Insurance agents selling new MA plans told seniors their doctors are covered by the new plans. Seniors who switched plans found out months later that their doctor is actually out-of-network, and they have to pay out-of-pocket to visit their doctor.
  • Some seniors received mailers that look like official business from a federal agency, yet the mailer was a marketing prompt from an MA plan or its agent or broker.
  • Some seniors receiving about 20 calls per day from insurance agents trying to convince them to switch their Medicare coverage.
  • Widespread television advertisements with celebrities claiming that seniors are missing out on benefits, including higher Social Security payments, as an attempt to persuade seniors to call MA plan agent or broker hotlines.

Agents were also found signing up beneficiaries for plans under false promises – for example, telling a beneficiary that a plan’s coverage network includes their primary doctor and/or other providers even when they don’t. Of particular concern to the committee were reports across states of agents changing vulnerable seniors’ and people with disabilities’ health plans without their consent. This is serious and can cause harm to beneficiaries who are unable to access the medical care they need and are depending on.

Some of the many actions the committee recommends to CMS include:

  • Reinstating MA plan requirements loosened during the Trump administration.
  • Monitoring MA disenrollment patterns and using enforcement authority to hold bad actors accountable.
  • Requiring agents and brokers to adhere to best practices.
  • Implementing robust rules around MA marketing materials and closing regulatory loopholes that allow cold-calling.
  • Supporting unbiased sources of information for beneficiaries, including State Health Insurance Assistance Programs and the Senior Medicare Patrol.

How to protect yourself from such scams

As Medicare’s Open Enrollment ends December 7th, we’re in the final stretch to review your coverage options for 2023. To protect yourself or loved ones from potential scams when looking for a Medicare plan:

  1. Use caution if calling a helpline advertised on television.
  2. If you think you have been enrolled in a new plan that doesn’t work for you, call your local SHIP (which is the Health Insurance Counseling and Advocacy Program in California at 1-800-434-0222) or 1-800-MEDICARE for help.
  3. Be careful what you click.
  4. If you come across suspected Medicare fraud, report it to our California Senior Medicare Patrol at 1-855-613-7080.

For more information, view the full report: Deceptive Marketing Strategies Flourish in Medicare Advantage.