Rules Rein in Medicare Advantage Marketing

Regulators clamped down last fall on shady sales practices for privately run Medicare health insurance for the elderly.

In this June 8, 2009 photo, a patient, left, participates in rehabilitation in the Traumatic Brain Injury Unit at Jamaica Hospital in New York. (AP Photo/Seth Wenig)

(AP)

New regulations for the plans, known as Medicare Advantage, banned unsolicited phone calls and door-to-door sales. They stopped agents from churning up commissions by switching customers to new policies. Meals tied to marketing activities also are now forbidden.

But customers and advocate groups say the plans' confusing nature still leaves room for pitches bordering on the deceptive, and abuses still crop up.

Seniors report being pressured with unsolicited phone calls or home visits that are clearly prohibited. Some have signed up for plans that didn't include their longtime doctors or hit them with unexpected costs, things they learn weeks later.

"I think the real issue is that people are not getting what they thought they would be getting," said Vicki Gottlich, senior policy attorney for the Connecticut-based Center for Medicare Advocacy.

Medicare Advantage plans are privately run versions of the government's Medicare program, which provides health coverage for the elderly and disabled. The government subsidizes these plans, and the industry has developed what can be a mind-numbing array of them.

The plans offer basic Medicare coverage topped with extras or premiums lower than Medicare's standard monthly rate of about $96.

Private fee-for-service plans, which don't involve doctor networks, are frequent complaint targets, said David Lipschutz, an attorney with the nonprofit California Health Advocates.

"The plans are pitched as allowing you to see any doctor you want, which is only half true," he said. "The doctor has to accept it."

Wichita, Kan., resident Willa Conners had no interest in leaving her Medicare Advantage plan when an agent made an unsolicited call to her earlier this year.

But Conners, 69, said the agent — whom she declined to name — offered a new Medicare Advantage plan with no monthly premium. He then pressured her to decide during a home visit in March.