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Medicare News
Senior Citizens Deceived by Medicare Private Health
Plans Can Leave Plans
Medicare Rights Center says CMS fails to
explain disenrollment
Aug. 6, 2007 - People in private Medicare health
plans can disenroll from their plans if they signed up after receiving
misleading information, according to the Centers for Medicare and
Medicaid Services (CMS). To date, however, neither CMS nor the insurance
companies that operate Medicare private health plans have informed
people enrolled in these plans that they can leave if they were duped
into signing up.
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CMS has received thousands of consumer complaints
about unscrupulous and aggressive sales tactics and seven companies have
suspended marketing of their private fee-for-service plans.
“We applaud CMS for acknowledging the fraudulent
marketing activities of private plans, but our concern now is righting
the wrong,” said Robert M. Hayes, president of the Medicare Rights
Center, a national consumer service group.
“While CMS informed their own hotline operators
that Americans with Medicare have the right to leave plans they were
tricked into joining, most consumers remain in the dark about their
right to change their Medicare coverage. What good is a new
disenrollment period, if no one knows about it or how it works?”
The new right is known as the “exceptional
circumstance special enrollment period” (SEP). Under CMS rules, most
plan members are locked into their plans after March 31 for the rest of
the year. More than 8 million people with Medicare are enrolled in
Medicare private health plans this year.
The Medicare Rights Center requested details from
CMS on how the SEP works because no official guidance about required
time frames or other specifics has been released, other than a
one-paragraph notice sent in June to State Health Insurance Assistance
Programs (SHIPs), which counsel people with Medicare. CMS responded by
providing the Medicare Rights Center with a summary of a script used by
Medicare’s hotline customer service representatives. After CMS sent
this summary, last month it sent a one-page memo about the SEP to
private health plans and other organizations.
According to CMS, plan members can find out if they
can change their coverage by calling the 800-MEDICARE hotline. Further
information obtained from CMS by the Medicare Rights Center says that
they should provide as much detail as possible about the misleading
information they were given, including, for example, the name of the
person who provided the wrong information, along with the date and
time. Documentation is not necessary.
Claims of misleading information can be made
whenever the plan member discovers that a promised benefit is in fact
not available. Staff at CMS regional offices will handle these claims
“with a high priority,” the summary states, but does not explain how
long the disenrollment process should take.
The summary provided to the Medicare Rights Center
also describes several examples of misinformation that would entitle the
member to switch to a different plan. If the member was told that:
● all health care providers participate in the
plan when they do not;
● incorrect assurance that they can transfer to
traditional Medicare at any time;
● other misleading information intended to
convince an individual to enroll.
The new plan would begin the month after the member
cancels the old plan or disenrollment can be retroactive. With
retroactive disenrollment, the new plan would cover past bills that the
previous plan did not, and begins the same day the previous plan took
effect.
A copy of the CMS summary, entitled “New
Exceptional Circumstance SEP Based on Incorrect or Misleading
Information,” is available online at
www.medicarerights.org/TkptsMASEPScript.pdf and the memo to private
health plan sponsors is available at
www.medicarerights.org/mislead-SEP-20070718.pdf.
Consumers who meet the disenrollment criteria but
have been unable to disenroll from their private health plans or
Medicare should call the Medicare Rights Center for free counseling
assistance at 800-333-4114.
Medicare Rights Center (MRC) claims it is the
largest independent source of Medicare information and assistance in the
United States. Founded in 1989, MRC helps older adults and people with
disabilities get high-quality, affordable health care.
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