Блог Анкара

In This Chapter

^ Protecting yourself against outright scams

^ Resisting aggressive and unethical sales tactics

Edicare Parts C and D are commercial marketplaces where products (in this case, Medicare health plans and prescription drug plans) are sold to consumers (Medicare beneficiaries). And like every other marketplace, they attract their share of swindlers and rip-off artists whose sad aim in life is to separate unsuspecting customers from their money.

But you aren’t going to be easy meat! You aren’t going to give those creeps any chance to exploit your uncertainties and trust! You may not come up against any of them at all, but if you do, you’ll be prepared. Why? Because I’m going to show you how to see through their deceptions and sweet talk so you know when to show them the door, hang up the phone, or walk away.

In this chapter, I explain how to be on your guard against two quite different types of deceptive practices: the outright scam and the hard sell. I also suggest what you can do — maybe even to reverse the situation — if you do get ripped off.

Steering Clear of Outright Scams

An Outright scam Is when some thief pretends to be from Medicare, Social Security, or a Part D plan and asks for sensitive information — such as your Social Security, credit card, or bank account number — in an attempt to steal your identity or money.

Outright scammers have nothing to do with Medicare. They’re just using Medicare (and most often Part D) as a pretext to cheat you of your hard-earned cash. The scam may be relatively simple — like trying to con you into paying a nonexistent enrollment fee for a false Part D plan. Or it may be a much more serious attempt to commit identity theft.

Identity thieves hunt for key pieces of personal information — Social Security numbers (or Medicare IDs, which are the same thing), credit card or bank account numbers, and even dates of birth and mothers’ maiden names if they can get them. Whatever personal data they pull about you, identity thieves use it to buy merchandise, apply for new credit cards in your name, or make a profit by selling it to other identity thieves. Many of them have managed to buy big-ticket items, like houses, cars, and even expensive medical care, by successfully pretending to be someone else.

This crime not only robs people of money but also of their good credit rating, which is a much more worrying loss. Restoring your credit rating can take months or years of effort. Clearly, identity theft is a nightmare you want to avoid at all costs. That’s why I explain what you need to know in the following sections.

Red flags to Watch out for

BEH Scams happen unexpectedly. You answer the phone or the doorbell and find someone who sounds or looks perfectly respectable offering to help you. How can you tell whether to trust this person? Here are some pointers you should recognize as instant red flags:

A person at your door saying he’s from Medicare or Social Security:

The real agencies never send anyone to your home on official business without an appointment.

A person claiming he represents a particular Part D plan: No one can

Come to your home uninvited to sell any kind of Medicare insurance. Doing so is illegal. Also, Medicare prohibits plans from cold-calling you on the phone. They can call only at your request. So if someone calls without your permission, it’s probably a scam.

A person asking for an enrollment fee or an advance premium payment: You should never have to pay for someone to enroll you in a Medicare health or drug plan. Nor should you pay any one-time payment that supposedly takes care of your premiums for months, years, or forever. Neither the enrollment fee nor the advance premium payment exists, so asking for either is illegal.

A person requesting your personal financial or identification information: Never ever give out your Social Security or Medicare ID number, or any details about your credit cards, bank accounts, or other financial information — especially on the phone. Legitimate callers don’t ask for this info.

A few lies already reported to Medicare

Con artists dream up new and creative ideas all the time for ways to target older Americans and steal their money and/or identities. Following are some typical scams involving Medicare and Part D that seniors have reported:

The loss of Medicare coverage threat: The caller claims to be a government official needing to check your Social Security (or Medicare ID) number — and threatens or implies that if you don’t provide it, you’ll lose your Medicare coverage. Medicare already has these numbers. You can’t lose Medicare benefits by refusing to give them out.

The Medicare refund tactic: The caller claims to be from Medicare, says you’re due for a refund, and asks for your bank account number in order to deposit your money. This refund doesn’t exist; if it did, Medicare wouldn’t contact you this way.

The "no more cash" routine: The caller claims to be from Medicare or another agency that sounds official and says that under a new Medicare rule you’ll no longer be able to pay cash for your Part D co-pays at the pharmacy. Instead, you must pay by credit or debit card, so of course the caller needs your card number on file, for security purposes. No such Medicare rule exists. You can pay for your drugs any way you please.

The bogus Part D enrollment fee: The caller claims to be from a Part D plan, offers to enroll you for a fee, and asks you to pay by credit card. No plan or fee exists. Asking for a Part D enrollment fee is illegal.

The automatic premium deduction trick: The caller claims to be from a Part D plan, supposedly enrolls you on the phone, and asks for your credit card or checking account number so the premiums can be automatically deducted every month. This plan doesn’t exist. No real Part D plan can enroll you on the phone — unless you make the call — or ask for payments or financial information over the phone.

The ol’ "Medicare’s going out of business" line: The caller claims to be a federal official, tells you that Medicare is discontinuing its services, and says that you can buy a plan that provides a similar service. This scam’s a real whopper! Medicare isn’t going away.

You’re probably not going to encounter any of these scenarios. But it’s wise to be alert to the possibilities, because being forewarned is good protection. And what if one of these situations does happen? You can hang up the phone or shut the door. You can say firmly that you’re not interested. Yes, you can, even if you feel doing so is impolite! Don’t be deceived by a friendly voice, a charming smile, a willingness to chat, or an apparent interest in your health and lifestyle. Con artists are experts at controlling the conversation to win your confidence and keep you on the phone or get invited inside. These people don’t care about you. They’re criminals who see you as a potential sucker. So show them you’re not.

Who to contact to report a scam

The scams in the previous section are known only because seniors on the receiving end took the trouble to report them. Authorities who hear such reports send out alerts so the scams become widely known and more consumers are put on their guard. So if someone tries to scam you, do everyone a favor by reporting the incident to any of these offices:

Your state’s attorney general or insurance commissioner. (Their phone numbers are in the state pages of your phone book.)

Federal Trade Commission — the official consumer protection agency.

• Call its toll-free help line at 877-382-4357 (TDD: 866-653-4261).

• Write to FTC, Consumer Response Center, 600 Pennsylvania Ave. NW, Washington, DC 20580.

• File a complaint online at Www. ftc. gov.

Inspector General of the Department of Health and Human Services.

• Call 800-447-8477 (TDD: 800-337-4950).

• Write to the Inspector General, HHS, Attention: Hotline, 330

Independence Ave. SW, Washington, DC 20201.

• Send an e-mail to HHSTips@oig. hhs. gov.

Actions you can take if you’re ripped off

Suppose you fall for a scam, despite your best intentions. You may be able to stop a payment by contacting your bank or credit card company immediately, before the transaction clears. Similarly, if you give your credit card or checking account number to someone who uses it to buy items without your consent, the credit card company or bank usually refunds the money — even if it has already been taken out of your account — after you report the theft and the company investigates it.

IJjjj|kB£^ If you give out any personal information — such as your Social Security or Medicare ID number, or your credit card or bank numbers — you should seriously assume that you may be a victim of identity theft, even if you don’t immediately see any evidence of it. The following can give you excellent advice on what to do next:

The Privacy Rights Clearinghouse: This California-based, nonprofit consumer organization provides assistance and information to likely or actual victims of identity theft. For fact sheets on identity theft, call 619-298-3396 (or write to Privacy Rights Clearinghouse, 3100 Fifth Ave., Suite B, San Diego, CA 92103). You can also read the fact sheets online at Www. privacyrights. org/identity. htm.

The Federal Trade Commission: This agency provides an Identity Theft Hotline for consumers (877-438-4338) and a guide, Take Charge: Fighting Back Against Identity Theft. You can call the hotline for a free copy (in English or Spanish) or find it at Www. ftc. gov/idtheft. Go to the same Web site to obtain more information and a complaint form.

Stories from the front lines

Soon after the hard-sell tactics used by some sales agents became publicly known, I invited readers of the AARP Bulletin To let us know if they’d encountered any. Here are a few of their stories:

Bobby, a 75-year-old retired construction worker living in Oklahoma, was happy with his coverage from traditional Medicare and veterans benefits. "I’d been in Medicare since 1985," he said. "I wasn’t going to do anything to jeopardize that." But he listened when the saleswoman came to his home and sold him what he thought was a Medigap policy. "She said it was supplementary insurance that paid what Medicare didn’t," he recalled. "She lied to me." Soon afterwards, he was rushed to his local hospital in a coma and spent ten days there. It was only then that he discovered she’d actually signed him up for a Medicare HMO. Bobby’s hospital wasn’t in the HMO’s provider network, and the plan refused to pay his $45,000 bill. It did pay finally, because plans must cover emergency care. But Bobby — while still believing he was in traditional Medicare and able to go to any hospital — had already started a course of radiation treatment costing $16,000, which the plan also refused to pay. Eventually, after disenrolling from the HMO and enduring months of hassle, Bobby was able to get Medicare to pay for his treatment retroactively.

Elinor, a 79-year-old retired nurse living in Florida, had recently been widowed

And was stressed out after caring for her husband through a long, difficult battle against cancer. She knew she didn’t want the Medicare HMO plan the saleswoman was pitching. "But she kept pushing," Elinor said. "And because I wasn’t in the best frame of mind at that time, in order to get her the heck out of the house, I signed the paper." Soon after checking with her doctors and finding they didn’t accept the plan, Elinor wrote canceling the enrollment (as the agent had told her she could) and thought that was that. But the first time Elinor tried to fill a prescription, using her old stand-alone Part D plan card, the pharmacist told her she wasn’t covered by it any more — she was in an HMO. It took six months of constant calls before Elinor was finally able to disenroll from the HMO and return to her original coverage from traditional Medicare, the Part D plan, and Medigap insurance. "I should never have had to go through this nightmare, all because of that insensitive, fraudulent agent," she said. "Normally, I never sign things. But I got caught at a bad time when I was vulnerable, and she used it."

Eva and her husband, who live in North Carolina, had a Medigap supplementary policy that was becoming increasingly expensive. It had reached almost $300 a month for both of them by the time she got a call from someone asking about supplementary insurance. So she agreed for a salesman to come to their home to talk about it. "This man came and said he

(continued)

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Could offer insurance for $98 a month," she said. "It was the $98 that sold me, I guess. But never once did he say it was a Medicare Advantage plan." In fact, it was a Private Fee-for-Service type of MA plan. And although the salesman told her it was "good anywhere," Eva quickly found that none of her local doctors or hospitals would accept it. Getting disenrolled from the plan

Was "the worst rigmarole I’ve ever seen." And she met others who’d had the same experience. Like them, she said, "I just thought I was buying a cheaper supplementary policy."

Reprinted from the October 2007 issue of the AARP Bulletin, A publication of AARP. Copyright 2007 AARP. All rights reserved.

Resisting Hard-Sell Marketing Tactics

The Hard sell Is when a plan’s salesperson or an independent insurance agent uses aggressive or unethical tactics — such as bait-and-switch — to try to push you into signing up for a plan you don’t want or whose consequences you don’t understand.

Part D plans and Medicare health plans aren’t supposed to pressure or mislead you into buying one plan versus another. Medicare has rules to prevent such practices — though arguably not enough — and some of the plans themselves have voluntarily agreed to a code of conduct designed to stop what they call "rogue" salespeople from making hard sells. Still, hard sells can (and do!) happen.

You may never meet the kind of hard-sell tactics I warn about in the following pages. But whether you’re a Medicare beneficiary or someone looking out for an older relative, being alert to the possibilities and knowing how to protect yourself (or your loved one) against such pressures is wise.

In the next several sections, I describe types of salesmanship to be aware of and suggest three lines of defense for resisting marketing pressure. The most important of which is understanding at least the main differences among kinds of Medicare insurance and the consequences of changing from one type to another. I also share the rules on what plans can and can’t do when trying to make a sale — and checks you can make before signing on the dotted line. Finally, I explain what you can do to reverse the situation if you’re tricked or misled into joining a plan you don’t want or understand.

Assessing different kinds of salesmanship

You need to be able to distinguish among three kinds of salesmanship, ranging from the acceptable through the unethical to the downright illegal:

Straightforward salesmanship: Agents accurately describe the plan they’re paid to pitch (whether a stand-alone Part D plan, Medicare Advantage health plan, or Medigap policy) and clearly explain how it’ll add to, or change, the consumer’s existing insurance. This plan may not be the best one for the consumer — only an impartial comparison of several plans can determine that, as explained in Chapters 9 and 10 — but the agents are doing their job fairly.

Unethical bait-and-switch: The consumer is interested in a standalone Part D plan or Medigap insurance. But the agent is trying to sell a Medicare Advantage plan without being honest about the consequences of making that change. The consumer may be persuaded to sign up for the MA plan, not understanding that it can mean losing her current doctors and hospitals in traditional Medicare, her existing drug plan, her Medigap insurance, or in some cases, her retiree health coverage.

Illegal enrollment: In the worst cases — not common, but known — agents say or do anything to get a signature, usually for enrollment in a Medicare Advantage plan. This sales approach includes the following:

• Saying consumers will lose Medicare or Medicaid benefits if they don’t sign or saying that Medicare’s ending

• Entering nursing home rooms uninvited

• Signing up very frail or mentally ill people who can’t properly make a decision

• Telling people their signatures are needed only to confirm that they’ve met with the agent

• Forging signatures on the enrollment form

All of these tactics are exploitative and prohibited by law. Selling Medigap insurance to anyone already enrolled in an MA plan is also illegal.

How can such scenarios happen? After these sorts of tactics first became publicly known in 2007, Medicare announced a crackdown on abuses and set tougher rules for the hiring and training of sales agents. In 2008 Congress prohibited certain practices. Perhaps these regulations (described later in this chapter) are now curbing the most disgraceful kinds of exploitation. But one underlying problem hasn’t changed, at least at the time I’m writing this book.

Plans are still allowed to pay agents higher commissions for selling Medicare Advantage plans than stand-alone drug plans. For example, agents may be paid $40 to $80 for each stand-alone Part D plan they sell, but up to $500 for each Medicare Advantage plan. (That’s because MA plans are far more profitable for the insurers.) So it doesn’t take a rocket scientist to see that the system encourages abuse. Unless Medicare requires individual insurers to offer the same commission for every type of plan they sell, it’s difficult to see how hard-sell tactics can be outlawed completely. Unscrupulous agents will always be attracted by bigger bucks.

Understanding the Various types of Medicare insurance

How is it possible for sales agents to persuade people to sign up for Medicare Advantage plans they don’t want? Are these folks dumb, or what? Absolutely not! Sometimes their signing can be the result of bullying tactics that take advantage of a senior’s vulnerability, as in some of the experiences described in the nearby sidebar "Stories from the front lines." But often it happens because people simply aren’t armed with their first line of defense: They don’t understand the differences among varying types of Medicare insurance. And who can blame them?

Just think how many types are out there, all with Medicare in their names. Traditional Medicare. Medicare Advantage. Medicare Medical Savings Accounts. Medicare (Medigap) supplementary insurance. Medicare drug coverage. And those types are just the broad divisions. You can’t even rely on the names of the insurers to tell them apart. Many large insurers sell Medicare Advantage plans, Medigap policies, and stand-alone Part D plans.

Now’s a good time to take another look at Table 1-1 in Chapter 1, where you can see at a glance the broad differences between each type of Medicare insurance. I explain in more detail how the different types of Medicare Advantage plans vary from each other, and from traditional Medicare, in

Chapter 9.

Here, I focus on what you need to know to avoid being Misled By a sales agent. I emphasize Misled Because there’s nothing wrong with choosing a Medicare Advantage plan when you know what you’re buying. Millions of people enrolled in them are satisfied with their coverage. But if you’re in traditional Medicare now and someone actively tries to enroll you in an MA plan, be aware of the following consequences of switching:

You’ll receive your Medicare benefits through the MA plan — not through traditional Medicare — and must accept the plan’s conditions.

You may not be able to go to the same doctors and hospitals that treat you now in the traditional Medicare program.

If you enroll in a Medicare HMO or Special Needs Plan that restricts your choice of doctors and hospitals to those in its network, and you go outside of that network, you’ll be responsible for the full cost of the treatment — except in an emergency. (In an emergency, the plan must cover your treatment anywhere.)

If you enroll in a Private Fee-for-Service plan and are treated by a doctor or hospital that doesn’t accept the plan’s terms and conditions, you’ll be responsible for the full cost of the treatment — except in an emergency. Also, a provider can decide whether or not to accept the plan’s coverage on each visit a patient makes.

I If you enroll in a Medicare Medical Savings Account Plan (MSA), be aware that after you use up the money deposited into your account, you’ll be responsible for the full cost of any medical services until you meet your deductible. One or two days in the hospital can completely gobble up the typical deposit amount. (The structure of an MSA is similar to a Part D plan in that they both have a gap in coverage in the middle. In a drug plan, it’s the doughnut hole; in an MSA, it’s the deductible.)

I If you have standard Medigap supplementary insurance, you can’t use it to cover your out-of-pocket expenses in an MA plan. Medigap policies can be used only with traditional Medicare.

I If you’re enrolled in a stand-alone Part D plan, this coverage is

Automatically canceled as soon as you’re enrolled in an MA plan — even if the MA plan doesn’t provide drug coverage.

I If you have retiree health insurance from an employer or union, you may lose this coverage by being enrolled in an MA plan. (For more about this possibility, see Chapter 6.)

In addition, here are a couple of tidbits to be aware of when listening to pitches for Medigap supplementary policies or stand-alone Part D plans:

I Medigap policies typically cover out-of-pocket expenses in traditional Medicare no matter which hospital or doctor you choose, anywhere in the country. Medigap SELECT policies are the exception. They have lower premiums but require you to use specific hospitals, clinics, and doctors within a geographical area (except in an emergency) in order to receive the insurance benefits.

I Individual insurers typically offer two or three different stand-alone Part D plans. The one with the highest premium is usually an enhanced plan with extra benefits (for example, some coverage in the doughnut hole, also known as the coverage gap; see Chapter 15 for an introduction). If you don’t need these extras, the higher premium may not be worthwhile. The only way to decide — and avoid undue pressure to buy the most expensive plan — is to compare plans properly according to the drugs you take, as explained in Chapter 10, instead of relying on a sales pitch.

Getting familiar with Medicare marketing rules

Knowing the can’s and can’ts of what plan sponsors or their sales agents are allowed to do when selling their products is your second line of defense in spotting whether a sales pitch is out of line and should be mistrusted. Medicare has had most of the following regulations in place for several years, but some are tougher rules put into effect after the marketing abuse scandal erupted. All refer to both Medicare Advantage health plans and stand-alone Part D plans, unless otherwise stated.

Medicare allows plan sponsors to

I Send promotional materials to you through the mail — but not enrollment forms.

I Send sales reps to your home — but only with your prior permission and only to discuss the single type of coverage (for example, stand-alone drug plan, Medicare Advantage plan, or Medigap insurance) that you specify when making the appointment.

Give sales presentations in public places like shopping malls or hotels. icare doesn’t allow plan sponsors to Send salespeople to your home uninvited.

Telephone you directly to make a sales pitch — Unless You invited the call or already have a relationship with the plan.

Tell you that a home visit is required for the purpose of explaining details of the plan or for you to enroll in it.

Ask for personal information on the phone, including your address, prescription meds, Social Security number, credit card or bank account numbers, or any other financial information.

Enroll you in a plan on the phone — unless you call the plan.

Give sales presentations or distribute enrollment forms in doctors’ offices, hospitals, pharmacies, long-term care facilities, or anywhere patients go to receive healthcare-related services (except in common areas such as public lounges at such facilities).

Give sales presentations at educational events such as health information fairs and community meetings.

Offer free gifts, cash, meals, or other giveaways to encourage you to enroll in a plan

Medicare requires plan sponsors to

I Explain clearly in their marketing materials and verbal sales pitches that not all doctors and hospitals accept their Medicare Advantage plans.

I Ensure that any independent sales agents they hire are licensed by the state in which they work.

I Guarantee that sales agents are paid the same commission for each MA plan the sponsor sells in any given year. Also, that agents are paid the same commission for each stand-alone Part D plan the sponsor sells. (But a sponsor can pay commissions for MA plans that are different from stand-alone drug plans.)

F Train sales reps, independent insurance agents, and brokers who sell their products, and hire only those candidates who score at least 80 percent on a written test of their knowledge of the Medicare program, its rules, and the details of the plan(s) they’ll sell.

F Ensure that sales agents who meet with consumers to discuss a particular type of plan (such as Medigap insurance) can’t also, at the same meeting, discuss other types of plans (such as MA health plans or stand-alone Part D plans) but must instead schedule a separate appointment, at least 48 hours after the first, to discuss another.

F Call consumers who sign up for any MA plan to check that they understand its conditions and consequences, and allow them the opportunity to withdraw from the enrollment if they want to.

Thinking and checking before you sign

Taking the time to think and verify information is most certainly your third line of defense against signing up for the wrong plan. Never let anyone rush you into enrolling in a plan. If a sales agent tries to push you into signing on the dotted line before leaving (or before you leave a sales presentation) — well, that’s a red flag right there. If the agent asks for your signature just to confirm that he has met with you, that red flag’s on fire. A legitimate agent doesn’t ask. A legitimate agent respects your desire to think it over.

Ask for the agent’s name and contact information. Then take your time, preferably several days, to consider the plan carefully. You can also use this time to do some checking so you can make an informed decision:

F Read any sales material carefully, especially the fine print.

F Check that the plan is the kind you want — a Medicare Advantage health plan, a stand-alone Part D plan, or Medigap insurance. If it’s a Medicare Advantage health plan, check what type. (I explain each type of Medicare health plan in Chapter 9.) The sales material should say clearly what kind of plan it is. (Starting in 2010, the type of plan must be incorporated in each plan name.) You can also

• Look up its name and ID number in the back pages of your Medicare & You Handbook.

• Call the Medicare help line at 800-633-4227.

• Go online to Www. medicare. gov and click "Learn More About Plans in Your Area."

F If you’re considering a Medicare HMO, PPO, or Special Needs plan, but want to continue going to your preferred doctors and hospitals, verify that the plan covers them. You can call the plan and ask for its provider directory, or you can look at the directory on the plan’s Web site. You can also ask your doctors and hospitals whether they accept the plan.

If you’re considering a Private Fee-for-Service plan, check with your local doctors and hospitals to find out whether they accept the plan. (PFFS plans currently aren’t required to have a provider network. Starting in 2011, they must have written contracts with providers so that consumers will then be able to find out more easily which providers accept specific PFFS plans.)

If you’re considering any kind of Medicare health plan, and want prescription drug coverage as well, confirm that it covers drugs. Many MA plans don’t.

Knowing what to do if you’re misled into joining a plan you don’t Want

Medicare has some consumer protections for people who believe they were tricked or misled into enrolling in a Medicare Advantage health plan they don’t want, or joined without understanding the consequences. Here’s what you can do:

F Call the Medicare helpline at 800-633-4227 (TDD: 877-486-2048), explain the circumstances, and say you want a special enrollment period to disenroll from the plan and either switch to another MA plan or be reinstated in traditional Medicare. Your case will probably be investigated.

F If you have medical bills that the plan refuses to pay — for example, if you were treated by doctors and/or a hospital outside of the plan’s provider network when you thought you were still covered by traditional Medicare — call the Medicare help line and ask to be reenrolled into traditional Medicare Retroactively — that is, dating back to the time you joined the plan. Medicare will then pay any outstanding bills at its usual rate, and you’ll pay the usual share of the cost.

F If calling the Medicare help line doesn’t bring results, call again and ask to be put in touch with a caseworker at your regional Medicare office. Or ask the help line for the phone number of the regional office that serves your state. Then call that office to explain what happened.

In certain situations, you have the right to disenroll from your present MA plan and either join another one or switch to traditional Medicare, even if you can’t show that you were misled by a plan. I explain these circumstances in Chapters 9 and 17.

You can also get in touch with your State Health Insurance Assistance Program (SHIP — check out Appendix B for contact info) for help if you need to. And you can report sales agents who use unethical tactics to the offices of your state’s insurance commissioner or attorney general (these phone numbers are in the state pages of your telephone directory).

Chapter 12