Several Medicare Advantage fee-for-service plan sponsors will voluntarily suspend marketing their plans until officials at the Centers for Medicare and Medicaid Services can verify compliance with certain management controls.
The moratorium is part of an effort to halt deceptive marketing in the private fee-for-service Medicare market.
“While most agents and brokers are helpful and responsible in describing and explaining choices to beneficiaries, there are a few bad actors,” Abby Block, director of the Center for Beneficiary Choices at the CMS, said during a press briefing. “This voluntary agreement demonstrates that the plans are stepping up to ensure that deceptive marketing practices end and that beneficiaries fully understand what they are purchasing.”
From last December through April, CMS officials received about 2,700 complaints from beneficiaries regarding Medicare Advantage plans. Many of those complaints related to private fee-for-service plans. Ms. Block pointed out the 2,700 complaints are a small fraction of the 1.3 million Medicare beneficiaries enrolled in such plans.
Problems range from agents encouraging the misperception that private plans are just like Medicare and are accepted by all providers who accept Medicare, to cases in which agents told beneficiaries they are still enrolled in Medicare and are purchasing a Medigap supplemental insurance policy.
The private fee-for-service Medicare plans that agreed to suspend marketing are United Healthcare, Humana, WellCare, Universal American Financial Corporation (Pyramid), Coventry, Sterling, and Blue Cross Blue Shield of Tennessee. They account for about 90% of enrollment in private fee-for-service plans, said the CMS.
The plans were not singled out because of problems with their marketing practices. The concern is with rogue brokers and agents with whom these and other organizations may contract, she said.
The moratorium does not apply to enrollment and does not affect the employer market, where CMS has not received complaints of issues with marketing tactics. It will be lifted on a plan-by-plan basis when the CMS certifies a plan has management controls in place that meet conditions spelled out by the agency earlier this year. For example, plan sponsors must show all of their advertising, marketing, and enrollment materials and include model disclaimer language provided by the CMS that private fee-for-service Medicare plans are not the same as Medicare or Medigap and not all providers will accept the plan. All representatives selling products will have to pass a written test demonstrating familiarity with Medicare and fee-for-service plans. Plans must also provide a list of individuals who are marketing the plan upon request by the CMS or state agencies.
The CMS will be monitoring all private fee-for-service plans to ensure that they are not engaging in deceptive marketing practices.