SMP Helps Client Sort Out Agent Misconduct & Duplicate Coverage Issues

SMP Helps Client Sort Out Agent Misconduct & Duplicate Coverage Issues

While most insurance agents do an honest job to help clients find coverage that best suit their needs, others have ulterior motives that put making a profit above their client’s best interests. This is what happened recently to a Santa Cruz county beneficiary who came to our Senior Medicare Patrol (SMP) liaison for assistance.

In this beneficiary’s case, Mr. B had bought a Medigap Plan F when turning 65 in 2013. He was happy with this coverage, yet in December of last year, his agent who had sold him the Plan F 3 years prior, called him saying he knew of a better, cheaper plan for him to switch to. Mr. B met with his former agent, trusted him and signed up for this new plan to start January 1, 2017.

The agent, however, neglected to tell Mr. B that he must make sure to disenroll from his Medigap Plan F to prevent having duplicate coverage. He also blatantly lied, as he had Mr. B switch from a less expensive, more coverage Medigap Plan F to a more expensive, less coverage Medigap Plan G. For 5 months, from January through May of 2017, Mr. B unknowingly had duplicate coverage with 2 monthly premiums being automatically deducted from his checking account, which caused his account to be overdrawn.

When he realized what was happening he came to SMP to report his case and get help. One of our SMP Liaisons, Evelyn Taylor, is helping sort through the duplicate payments to providers, and has forwarded his case both to the Department of Managed Health Care for agent misconduct issues and to the California Department of Insurance, to help make sure Mr. B receives a refund for his 5 months of duplicate premium payments.

In addition, in reviewing his case, Evelyn realized Mr. B is eligible for Medicare Part D’s Extra Help, which will significantly lower his Part D plan and drug costs. He’s also eligible for a Medicare Savings Program, which will cover his Medicare Part B monthly premium, saving him over $1,600 a year.

This is just one of many examples the types of diverse cases our Senior Medicare Patrol can help with. If you or anyone you know has a similar or other issue regarding agent misconduct or Medicare fraud, call our SMP helpline at 1-855-613-7080. For cases regarding Medigap supplement insurance, make sure you get a copy of your Medigap enrollment form from your agent. This will help our SMP Liaisons review your case for agent misconduct. Medicare.gov also has some good tips to remember when buying a Medigap plan.

For any other Medicare or long-term care insurance issues, contact your local Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222.

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.