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Special coverage: Medicare

7 companies to suspend some Medicare marketing

By STEPHEN NOHLGREN
Published June 16, 2007

For months, people on Medicare have complained to state and federal authorities that aggressive insurance agents were enrolling them in private "fee-for-service" Medicare plans they didn't understand and didn't want.

Patients found that their long-standing doctors suddenly wouldn't treat them. Bills arrived from insurance companies they never heard of. And sometimes unwanted plans refused to cover much-needed medication.

To stop such abuses, Medicare's parent agency announced Friday that seven of the industry's biggest players have agreed to suspend marketing until protective measures take effect. Among the seven: Tampa's fastest growing publicly traded company, Wellcare Health Plans Inc.

The seven companies insure 90 percent of the 1.3-million Medicare beneficiaries with fee-for-service plans, said Abby Block of the Centers for Medicare and Medicaid Services.

Most abuses were caused by "rogue agents, " not the plans, Block said: "We are bound and determined, as the plans are, to shut those people down."

The marketing suspension affects only private fee-for-service plans, a recent option that theoretically lets people pick their doctors while the plan pays the bills. In practice, some doctors refuse to deal with the plans.

Marketing may continue for other types of private Medicare plans such as health maintenance organizations.

During the marketing suspension, the plans must review and revise all advertising and sales material to make sure they clearly state what is covered.

Plans must set up procedures for calling potential enrollees after an agent signs them up. Do they really understand the plan? Do they really want it?

Plans must develop written tests for agents, to make sure they understand Medicare and the plan's provisions.

When the federal government approves these and other procedures, the plans can resume marketing.

Included in the suspension are Wellcare, Humana and United Healthcare, all big operators in Florida. Universal Health Care, a St. Petersburg company whose "Any Any Any" plan generated many complaints, is already under a marketing and enrollment ban.

[Last modified June 16, 2007, 07:24:18]