Medicare fraud risk grows for some |
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But Lipschutz and others say some agents are less ethical. Unscrupulous agents use several tactics to sell their policies, they say. Although Medicare never contacts its beneficiaries by phone, some agents indentify themselves as Medicare representatives when cold calling seniors at home.
"That's a common tactic," Holland says.
Dual-coverage targets
Paul Precht, director of policy and communications for the Medicare Rights Center in Washington, D.C., says low-income seniors who have Medicare and Medicaid are particularly vulnerable to unscrupulous health insurance agents.
Seniors with dual coverage are able to change their plans once every month because they often have more chronic health conditions than patients covered only by Medicare, Precht says. Waiting months for the next enrollment period to change plans could be problematic for these seniors.
Some insurance agents see these dual-coverage seniors as prospects to boost enrollment and profits during the "off-season" from the annual open enrollment period.
Enticed by freebies such as cell phones or eyeglasses, seniors are assured by hard-selling agents that their benefits will remain the same or improve, and that their physician is included in the private plans' network.
After they enroll, however, seniors often find they were swayed by empty promises. In the worst cases, they are caught without coverage and stuck paying medical costs out of pocket.
Kuchler acknowledges that consumers who consider enrolling in Medicare Advantage need to do their homework first.
"Along with (increased) choice comes the need to do one's research to pick a plan that best meets your situation in terms of health needs and finances," he says.
Staying safe
Fortunately, there are many other things seniors can do to avoid becoming a victim of Medicare fraud.
Vigilance is the best protection against fraud. Lipschutz advises seniors to protect themselves by keeping a healthy skepticism toward any health insurance agent.
"Never feel pressured, and do your homework by assessing the coverage you have," he says.
He also recommends double-checking every claim made in a sales pitch.
"Trust, but verify," he says. "Well, maybe not trust."
Holland advises seniors to be especially suspicious of any unsolicited contact with an agent.
An agent's cold call or a knock at the door is a bad sign. In July, Congress passed the Medicare Improvements for Patients and Providers Act of 2008. The law provided marketing restrictions, including prohibiting telemarketing and door-to-door solicitation, and providing meals to prospective clients as part of marketing activities.
Outside help is also available. To help Medicare beneficiaries navigate the many health insurance options, the federal government offers the services of senior health insurance program counselors, also known as SHIPS.
SHIPS counselors go through a five-day crash course on health insurance options. Many are volunteers. Others are social workers who have taken the training to better serve their clients.
These counselors do not choose a health insurance plan for inquiring seniors and have no financial stake in a senior's final decision.
"We don't have that bias," said Darlene Sampson, who directs Pennsylvania's SHIP, which is called the Apprise Program. "We're able to review the risks and benefits to the consumers."
Links to all 50 states' programs are available at the Centers for Medicare and Medicaid Services Web site. Medicare has made "Medicare and You 2009," a 128-page summary of the program, available for download at its Web site.
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