Be Wary of Medicare Plan Phone Solicitors or Caveat Emptor: Buyer Beware

A group of local agents recently shared concerns about the marketing methods of phone solicitors, particularly as it relates to the Medicare Advantage plans in far Northern California.

With the current Covid situation, electronic enrollments to a plan can be a real blessing. They can also be a curse when an individual does not understand the product to which they are enrolling. One example was provided by Margy Wenham, Redding Medicare Insurance Broker.

“I received a call from a gentleman last week, concerned that he got enrolled in the AARP/United Health Care HMO. He said he doesn’t know how. He remembers phone solicitors, but knows he did not give out Medicare number. After I explained that I could not assist him as I am not his agent, he said he would call UHC to dis-enroll and file a complaint. I am afraid we are going to see a lot of this! “

Barbara McClaskey reports multiple similar situations. One person was enrolled in the Anthem Medicare Advantage Plan without the individual’s permission. Her resolution for one case was to do a 3 way call with his current carrier (AARP) and request that they do not cancel his supplement plan, because it was not yet January 1. The insurer allowed the exception, but would not let him enroll in another drug plan. They would keep his current Rx plan with them since he was cancelling the Advantage Plan as never being enrolled.  She then called Anthem with the client and cancelled their plan as never taking effect.  Since the AEP (Annual Election Period) ended 12/7, there is no opportunity to make a change of Rx plans.

Ms. McClaskey added, “We get several calls a day from clients asking us about these plans being sold on TV.  They were also getting very pushy salesman calling them many times pushing them to buy.”

“One client mentioned that he did not even let them know he wanted the plan. They were to only send information.  The solicitor enrolled him in UHC HMO.  The out of town agents do not know this community or understand the limited access to doctors in our area. They were also told that they were not going to have to pay their Medicare Part B premium.  Of course, this is not true unless the individual is eligible for Medi-Cal.  I have never seen such a dishonest and manipulative sales force as these online solicitors!” McClaskey said.

The MAPD (PART C) plans are bundled plans that include the Part D Rx benefit and are packaged by an insurer. Medicare. Northstate premiums are very attractive premiums ($30-59 monthly). Often the plans include additional but very limited benefits such as hearing aids, vision or dental benefits. There are copays and deductibles.  The yearly maximum out of pocket in the event of a very serious illness is $6700, but does not include the Rx True Out of Pocket of $6550!

This is different than a Medicare supplement that pays without regard to a network.  With Medicare and a supplement, all you need to know is if your provider takes Medicare at some level. It would leave you with little or nothing out of your pocket for covered Medicare services and give you more freedom of choice of providers.  Rx out of pocket costs will depend on the Rx you use and your drug plan.

The United Health Care plan is an HMO, which means you must use their providers or you receive NO benefits. Note: UCSF and UCDavis are not in the network. You may access the network at: www.UHCMedicaresolutions.com.  Scroll down and Click on Find A Provider, enter you zip code and choose Secure Horizons (HMO). If you would be changing doctors, be sure the provider is taking new patients!

The Anthem product is a PPO which allows you to go out of network and receive lesser benefits. You may search doctors at: https://www.anthem.com/medicare/medicare-advantage-plans/.  Enter your zip code and 2021 plan year. Choose the Anthem MediBlue Access (PPO).
Review each plan’s formulary to be sure how/if your drugs are covered.

Medicare has an excellent publication available to help you understand the differences: https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf.

One important fact to remember.  If the MAPD (Part C) plan does not work for you, you will have only ONE opportunity to return to Original Medicare and be “guaranteed issue” for a supplement. This is must happen in the first 12 months of enrollment. The “job aid” document for enrollment options for Medicare Plans includes 15 pages. Dis-enrolling and re-enrolling is not necessarily a simple transaction.

You have heard it before, “Caveat Emptor” or let the buyer beware. It is my opinion you are best served by a local agent who understands the local market and your needs.

Margaret R. Beck

Margaret Beck CLU, ChFC, CEBS started her insurance practice in Redding in 1978. She founded Affiliated Benefit Services.

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