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S. Hrg. 110-207 MEDICARE BENEFIT ADVERTISING AND MARKETING AS WELL AS SALES: THAT HAS THE ADVANTAGE? ======================================================================= HEARING before the SPECIAL BOARD ON AGING UNITED STATES US SENATE ONE HUNDRED TENTH CONGRESS FIRST SESSION WASHINGTON, DC MAY 16, 2007 Serial No. 110-8 Printed for the use of the Unique Committee on Aging Available by means of the Globe Wide Web: index.
GOVERNMENT PRINTING OFFICE 38-618 WASHINGTON: 2007 __ Up for sale by the Superintendent of Documents, United State Federal Government Printing Office Internet: book shop. gpo.gov Phone: toll complimentary (866) 512-1800; (202) 512091800 Fax: (202) 512092104 Mail: Stop IDCC, Washington, DC 20402090001 SPECIAL COMMITTEE ON AGING NATURAL HERB KOHL, Wisconsin, Chairman RON WYDEN, Oregon GORDON H.
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LINCOLN, Arkansas RICHARD SHELBY, Alabama EVAN BAYH, Indiana SUSAN COLLINS, Maine THOMAS R. CARPER, Delaware MEL MARTINEZ, Florida BILL NELSON, Florida LARRY E. CRAIG, Idaho HILLARY RODHAM CLINTON, New York ELIZABETH DOLE, North Carolina KEN SALAZAR, Colorado Standard COLEMAN, Minnesota ROBERT P. CASEY, Jr., Pennsylvania DAVID VITTER, Louisiana CLAIRE Mc, CASKILL, Missouri BOB CORKER, Tennessee SHELDON WHITEHOUSE, Rhode Island ARLEN SPECTER, Pennsylvania Deb Whitman, Staff Director Catherine Finley, Position Member Personnel Supervisor (ii)? C O N T E N T S ---------- Page Opening Statement of Legislator Herb Kohl ... ... ... ...... Block, director, Center for Recipient Choices, Centers for Medicare and Medicaid Services (CMS), Baltimore, MD.... 3 Panel II Sean Dilweg, Wisconsin Office of the Commissioner of Insurance Coverage, Madison, WI ... ... ... ... ... ... ... ... ...... 14 Kim Holland, Oklahoma Insurance Policy Department, Oklahoma City, OK ... 43 Sherry Mowell, Georgia Office of the Commissioner of Insurance Policy, Atlanta, GA. ... ... ... ... ... ... ... ... ...... 60 Panel III Karen Ignagni, head of state as well as CEO, America's Wellness Insurance Program, Washington, DC ... ... ... ... ... ... ...... 70 Heidi Margulis, senior vice president, Humana Inc., Louisville, KY. ... ... ... ... ... ... ... ... ... ... ... ... 86 Peter J. Clarkson, senior vice head of state, Distributions Operations, United, Health Group, Minnetonka, MN ... ...... 108 Gary Bailey, vice head of state, Medicare Operational Efficiency, Well, Treatment, Tampa Fl, FL ... ... ... ... ... ... ... ... ... Casey ... ... ... ...
143 Actions to Legislator Kohl's Inquiries from Abby Block ...... 143 Actions to Legislator Smith's Inquiries from Abby Block ...... 144 Responses to Senator Lincoln's Inquiries from Abby Block ... ... 149 Feedbacks to Senator Smith's Concerns from Commissioner Dilweg. 157 Reactions to Legislator Lincoln's Inquiries from Commissioner Dilweg 159 Response to Legislator Kohl's Question from Commissioner Holland ... 160 Actions to Senator Smith's Concerns from Sherry Mowell ... ... 161 Feedbacks to Legislator Smith's Inquiries from Albert Sochor ... ... 162 Reactions to Senator Smith's Inquiries from Karen Ignagni ... ... 163 Responses to Legislator Smith's Concerns from Heidi Margulis... 167 Actions to Legislator Lincoln's Inquiries from Heidi Margulis ... 174 Actions to Senator Smith's Concerns from Peter Clarkson... 188 Extra info submitted by the Oklahoma Insurance Department ...
... ... ... ... ... ... ... ... ... ... 206 Statement sent by Janet Stokes Trautwein, executive vice head of state and CEO, National Association of Wellness Underwriters. 260 National Insurance Policy Manufacturer Registry User's Overview . (Medicare Advantage Agent near me).. ...... 263(iii )MEDICARE ADVANTAGE MARKETING AS WELL AS SALES: WHO HAS THE ADVANTAGE? ------------ WEDNESDAY, MIGHT 16, 2007 U.S. The Committee satisfied, pursuant to notice, at 11:49 a. m., in room SD-106, Dirksen Us Senate Office Complex, Hon. Herb Kohl(chairman of the board)presiding. Present: Senators Kohl, Wyden, Whitehouse, as well as Smith. OPENING STATEMENT OF LEGISLATOR HERB KOHL, CHAIRMAN The Chairman. I thanks all for being here today, and also I say sorry for having kept you waiting an hour. We would certainly like to welcome you all below today. We specifically intend to thank our witnesses for taking time out of their busy timetables in order to be with us. Today, we will examine the sales as well as marketing methods entailing Medicare Advantage strategies. I wish to make it clear at the start that we are not taking any placement on the advantage or relative cost of Medicare Benefit. Instead, this focus and also our problem today is with the various as well as extensive complaints including the sale and also advertising of Medicare Advantage prepares, which are being aggressively promoted all over our country. For those of you not knowledgeable about Medicare Advantage prepares, they are private-plan alternatives varying from handled like private fee-for-service plans, which are offered to Medicare recipients as an alternative to standard Medicare. Prevalent complication as well as, in some situations, outright misrepresentation as well as even fraudulence, have been connected with the sale of these plans. Complaints seem nationwide and an unpleasant pattern has emerged. So today we will hear from more helpful hints two distinguished State insurance policy commissioners, Sean Dilweg of Wisconsin and also Kim Holland of Oklahoma. Our investigation has exposed a terribly regular image, one which just appears to be expanding. Many senior citizens acquiring Medicare Advantage strategies have actually been preyed upon as well as unintentionally benefited from by insurance representatives. Senior citizens have been removed from traditional Medicare without their expertise, authorized onto plans that they can not manage, misdirect regarding insurance coverage and told that their physicians accept these strategies when, actually, they do not. Among the most troubling troubles that we have seen entails insurance agents misstating and marketing Medicare Benefit plans in unsuitable manners in position such as within assisted living facility. We will certainly listen to a lot more regarding that from Sherry Mowell, an investigator from Georgia. Simply as seriously, many insurance-sales representatives simply do not comprehend the essential differences in between standard Medicare and also the wide variety of various other plans offered to seniors, including the Medicare Benefit prepares that they are peddling. We will additionally be finding out about the sales training received by the insurance agents offering Medicare Benefit strategies. At our demand, strategy enrollers have supplied the Committee with an array of well-developed and remarkably created training manuals and programs needed for those who offer Medicare Benefit. Regretfully, what is on paper does not constantly equate into the real life. To address this, I have actually started dealing with the National Organization of Insurance Policy Commissioners and other stakeholders to establish regulation that would certainly provide States increased authority to look after strategies and also agents. We are not suggesting today that CMS has done absolutely nothing to attend to these issues or that CMS officials are unconcerned aboutthem. It is clear that a significant separate in oversight exists; one that needs to be resolved right away. I delight in that today's hearing is already having a favorable result. In the recentlies, Medicare Advantage plans introduced initiatives to reform their marketing-and-sales technique standards. The Americas Health And Wellness Insurance Coverage Program, AHIP, is below today to review its new initiative to enhance training for its member representatives and brokers. As we understand, the number of Medicare Benefit prepares being provided to beneficiaries is expanding quickly. We should remain vigilant in our oversight of these strategies, and I intend to do so. If even more hearings are required to hold feet to the fire, after that we will do that. Cleaning up these marketing-and-sales practices is a high top priority of mine. We anticipate speaking with our witnesses today, with whom we will certainly function to identify and also deal with and also drawbacks in the marketing and also selling of Medicare Benefit plans. At this time, we want to call our very first panel witness, that Discover More Here is Abby Block. She is from the Centers for Medicare and Medicaid Providers, CMS. Block is the director of the Facility for Recipient Options at CMS. Prior to thinking her present obligations, she was an elderly expert to the CMS administrator. She has functioned extensively with the States 'health insurance plan as well as recipient advocacy teams on Medicare Advantage plans as well as the concerns we are going over today. We are extremely happy to have you with us today, Ms. Block, as well as we would be pleased to obtain your testament. DECLARATION OF ABBY L. BLOCK, DIRECTOR, CENTER FOR BENEFICIARY SELECTIONS, CENTERS FOR MEDICARE AND MEDICAID SERVICES(CMS), BALTIMORE, MD Ms. Block. Thank you for inviting me to talk about Medicare Benefit and also, in particular, advertising conformity. Functioning closely with Congress, we have refined Medicare Advantage throughout the years to advertise solid strategy engagement throughout the nation. With a vibrant industry of prepare for 2007, recipient enrollment is currently at an all-time high. I take pride in these successes and also stand devoted to function with you in the days in advance to protect option for individuals with Medicare. Such additional benefits vary by
plan, but can consist of: lower cost-sharing, improved Part D prescription drug coverage, Part B and also D premium decreases; and also, access to items as well as services like listening device, routine physicals or vision tests that original Medicare does not cover. Regardless of the programs'successes, CMS takes recent records of aggressive advertising and marketing of some items extremely seriously. I wish to talk today concerning
a few of the methods that CMS is building on lessons learned and also details collected during 2006. CMS enforcement for marketing violations ranges from issuing a caution letter or restorative action strategy to putting on hold registration as well as even, ultimately, ending a strategy from the program. This year alone, we have actually fined strategies greater than$ 400,000 in civil financial penalties for falling short to Read Full Report offer information to recipients in a timely fashion.
Our utmost issue is to help and also shield the recipient. Consequently, beneficiaries and also enrollees misinform by a plan are offered a possibility to change to an additional plan. Furthermore, during the very first quarter of annually, all enrollees currently have the chance to change out of personal fee-for-service strategies or any type of various other MA prepare for any kind of factor and also pick an additional option.
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Concerns involving scams and also misuse go to the medics, our program honesty professionals. CMS is taking lots of actions to recognize companies in demand of compliance treatment, consisting of monitoring complaints by performing secret shoppings of sales events across the country.
Specifically, CMS works cooperatively with the National Organization of Insurance Policy Commissioners as well as State departments of insurance policy to develop a model conformity as well as enforcement Memorandum of Comprehending. Far, 20 States and also Puerto Rico have authorized the MOU that will certainly enable us to share information concerning non-compliant advertising and marketing activities. CMS intends to issue quickly a proposed rule that will certainly help with oversight for Medicare Benefit plans and also Part D prescription medicine strategies.
We are holding plans accountable for the actions of both employed and also independent agents selling their products. I want to ensure you that the large bulk of elders that bought Medicare Advantage items are pleased with their strategies and also the solutions they are obtaining.
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Thank you again for the chance to talk to you today. I eagerly anticipate answering your questions. The Chairman. Thank you, Ms. Block. Before we reach questions for you, we would certainly like to learn through our Ranking Participant, Legislator Smith, along with Senator Whitehouse. Senator Smith. Thank you, Legislator Kohl, for calling this essential hearing on an extremely essential problem.