“We’re seeing an increase this year in that,” Sava said. “A member will go to the pharmacy and fill a prescription, thinking they’re an Independent Health member. They find out the plan they were misled into doesn’t even have prescription drug coverage.”
Independent Health representatives helped the patients re-enroll in plans offered by the company. Sava and Connolly declined to name the large national insurer responsible.
Part of the rise in complaints may be due to sheer number of plans available, along with the murky definition of “misleading.”
“Even if the information on the paper doesn’t appear misleading to you, that doesn’t mean an individual beneficiary who’s 85 years old maybe didn’t find it misleading or didn’t understand something that was said on the phone,” said Epstein Becker Green’s Fingold.
“In general, this is a fairly broad and difficult-to-police area,” she said.
Some insurance agents argue there are relatively few bad actors in the Medicare Advantage arena.
“It’s 0.14% of all enrollments that resulted in a marketing complaint. That’s a small number,” said Michael Keegan, senior advisor for strategic communications at Health Agents for America, a lobbying group for independent insurance agents.
He said the number of complaints increased during the COVID-19 pandemic because more people were staying home, watching TV and paying attention to the Medicare Advantage commercials. The rise in complaints could reflect an increase in marketing too, he said.
The jump also highlights how priorities change between political administrations, said Tricia Beckmann, a director at consultancy Faegre Drinker. Former President Donald Trump’s administration took a softer hand at policing Medicare Advantage marketing efforts than President Joe Biden’s administration.
Now, CMS and its regional offices are taking a closer look at which complaints could be categorized as marketing misconduct. CMS is investing in tools to more effectively search the central complaint tracking module to identify trends among specific brokers and insurers, she said.
“You need to have some type of querying tools to understand if these complaints are driven by specific common variables, like a common actor, common plan, common broker. That type of work is underway,” Beckmann said.
CMS plans to act on patient complaints it receives, as well as on its reviews of insurance agent calls with beneficiaries, a spokesperson wrote in an email. Insurers are required to investigate all allegations made against their contracted agent and terminate a contract if necessary, the CMS spokesperson said. The federal agency will work with insurers to report poor-performing agents to state insurance offices, where representatives could revoke their license to sell health plans.
But CMS didn’t respond to questions about how soon enforcement will begin, and about the full scope of potential enforcement against an individual broker.
“Some of these big brokers may contract with half or more of all the Medicare Advantage plans in the country. If they’re found to be doing something inappropriate or noncompliant, does that then get spread to all of the brokerage? What’s the ramification?” Fingold said.
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