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July 25, 2007

Insurance Commissioner Poizner Warns Seniors to Beware of Aggressive Medicare Marketing Schemes

SACRAMENTO - Insurance Commissioner Steve Poizner today warned California seniors and all Medicare beneficiaries to take special precautions when signing up for Medicare Advantage and Medicare Prescription Drug (Part D) coverage.

The California Department of Insurance (CDI) has discovered a recent increase in the number of complaints involving sales of Medicare Advantage Plans to California Medicare beneficiaries. Many agents are using the addition of Medicare Prescription Drug plans as a pretext to replace traditional Medicare plans with the new Medicare Advantage Private-Fee-For-Service (PFFS) plans that may not be suitable for the needs of the consumer. The complaints received by the Department of Insurance have involved aggressive marketing and enrollment of Medicare Advantage plans, misrepresentation of plan benefits, unnecessary replacement of existing Medicare coverage, lack of access to plan providers and forged applications.

"Deceiving vulnerable Californians to make an extra dollar is beyond the pale and will not be tolerated," said Commissioner Poizner. "As Insurance Commissioner, my number one priority is ensuring that consumers are protected from bad actors and potential losses. I urge seniors and all Medicare beneficiaries to be cautious when being solicited for these programs, and to contact the Department of Insurance should they have questions or encounter any problems."

Below are a few examples of specific complaints that have been reported to CDI:

Some agents have solicited Medicare beneficiaries for Prescription Drug plan coverage, persuading them to switch their existing coverage for a Medicare Advantage PFFS plan that included prescription drug coverage. The beneficiaries' providers refused to accept the PFFS coverage and several California residents lost their access to covered benefits for some period of time.

One agent provided seminars about the Prescription Drug Plan at a senior residential complex. Several residents complained that premiums for the drug plan were deducted from their monthly Social Security allotment without their knowledge and consent. The agent has been charged with numerous counts of forgery.

Medicare beneficiaries with a limited proficiency in English have been solicited by agents without knowledge of the beneficiaries' native language, using marketing materials printed in English. The beneficiaries were persuaded to enroll in Medicare Advantage plans that were unsuitable for their health needs and financial circumstances.

Medicare-related coverage including Medicare Advantage plans and Medicare Prescription Drug plans are very complicated and necessitate a thorough review of the individual's health care needs and access to providers before any decision is made to apply for new coverage or replace existing Medicare coverage.

Commissioner Poizner urges seniors and all Medicare beneficiaries to review the tips below and take the necessary precautions to protect themselves:

In most Medicare Advantage plans, there are extra benefits and lower co-payments than in the Original Medicare plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services. Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans are Medicare Advantage plans that have a directory or network of providers and hospitals covered by the plans.
PFFS plans are offered by private insurance companies. The insurer, rather than Medicare, decides how much it will pay to a provider and what you pay for the services you get. There is no directory or network involved. Make sure that your physician, hospital and other providers will accept the coverage you are about to enroll in before you sign up for new coverage or decide to change existing Medicare coverage. If your provider does not accept the PFFS coverage, you will be responsible for the full cost of the services provided.
Do not feel pressured to sign an application for coverage until you have made sure that the plan provides the covered care you need. If you do not want to change coverage, do not sign any forms or papers.
All insurers, brokers, agents, and others engaged in the transaction of insurance owe a prospective insured who is 65 years of age or older, a duty of honesty, good faith, and fair dealing.
Any questions you have about Medicare Advantage plans, Medicare Prescription Drug plans or Medicare Supplement coverage can be answered by the California Department of Insurance, Consumer Communications Bureau HOTLINE 1-800-927-HELP (4327) and at the Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222.

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Are you like the rest of us? You start every year the same way - determined to join a gym or start an exercise program that will make you thinner, fitter, and healthier. But in just a few weeks or months, your enthusiasm disappears and you're back to your old, inactive self – The Couch Potato!

According to AARP, “It's common to ‘fall off the wagon’ when you're trying to make a major change like getting active, quitting cigarettes, or eating healthier. That's because it's easier and more comfortable to go back to the old, familiar way of doing things. But sticking with a healthy change is well worth the effort.”

· Boredom…doing the same old thing over and over can diminish our interest in the exercise program.

· Lack of Time is a common excuse…but you CAN DO IT! Schedule time and follow through with your schedule.

· Pain and soreness is also an excuse. One woman who had a painful foot condition and had been cautioned by her doctor not to walk, run, jog, or use a treadmill, learned that the elliptical machines do not cause repetitive stress to the foot and she now does her aerobic exercises 3-5 times a week.

· Not doing what you like is another excuse. If you don’t like the treadmill, try dancing or aerobics, walking outside or biking.

So, if you want to stay interested in your program, be sure you to set aside time, overcome obstacles, and like what you take up. Try to join a gym that offers television and invest in earphones. Buy a portable CD player and play your own favorites during your workout. Vary your program…alternate some strength training with the aerobic walking, biking, treadmill or elliptical. If your gym has a pool, enter the swimming classes.

It’s always helpful to have a friend or group to exercise with. Having such a support network can keep you motivated. Working out with others can be lots of fun. Going to a health club several times a week gives you an opportunity to make friends you look forward to seeing each time you go. Walking with a friend can give you a chance to catch up or get to know someone better.

In order to avoid injury or burnout, try to pace yourself. Otherwise you might get discouraged and quit. Start out gradually, and build up by adding small challenges as you go along. But don’t give up!

If you have a schedule that keeps you busy, you can break your workout sessions into short, 10-minute sessions. Just try to do at least three 10-minute sessions 3-5 days a week. If you track your progress you will see how you improve week after week. The good thing about health clubs is that you can track your target heart rate on most machines. And of course you can track your weight. Consistent exercise and resistance training can help you lose weight. Appropriate diet also helps.

Remember, unless you have physical disabilities that preclude any type of exercise it’s good for you! Just ask your doctor. You’ll feel perkier, if you’re depressed your spirits will lift, and you will feel proud of your accomplishments.

For more information, consider reading “Exercise: A Guide,” by the National Institute on Aging, NASA, and the U.S. Public Health Service.