Effie Hubbard thought she had signed up for a private Medicare plan that would ease her worries about paying for health care.
MILTON HINNANT/DMN
Merlin Jones found that his wife's Medicare Advantage plan did not include prescription coverage or home health services for Ruby, who has Alzheimer's.
Instead, it only gave her headaches.
Soon after enrolling, the 73-year-old Dallas woman learned that doctors she had had for years didn't participate in the plan. What most upset her, though, was that her prescription drug costs jumped by a couple of hundred dollars a month.
MILTON HINNANT/DMN
After signing up for a private Medicare plan, Effie Hubbard, 73, found that her prescription drug costs jumped by a couple of hundred dollars a month and that doctors she had been going to for years didn't participate in the plan.
Ms. Hubbard lives on $627 a month from Social Security.
"I couldn't afford my medicine anymore," she said. "I'd like to find the woman who sold me this. I'd give her a piece of my mind."
So would many other frustrated seniors who have switched from the traditional Medicare program to private Medicare plans.
After tangling with prescription drug plans, older adults are running into problems with Medicare Advantage plans.
The private plans – sold under names such as Advantra, Sterling and WellCare – combine Medicare's basic physician and hospital coverage with additional benefits such as dental and vision care.
In the original Medicare program, the government pays beneficiaries' claims directly.
With the Advantage plans, the government pays private insurers to oversee their customers' health care.
The number of seniors in the private plans has grown by 60 percent since 2003 and accounts for 8.3 million of Medicare's 43 million beneficiaries, according to the Kaiser Family Foundation.
But with the surge in new members have come concerns that older adults don't know what they're buying and sometimes fall victim to questionable sales tactics.
Lue Taff, who manages the elder support program at the Senior Source of Dallas, says her staff has noticed a sudden uptick in complaints about the private plans.
"The seniors feel they've been misled, particularly if they've enrolled in one of the newer private fee-for-service plans," she said.
What to ask
The fee-for-service plans have had a sixfold increase in enrollment over the last 18 months and, according to advocates, are behind most of the recent dissatisfaction.
Unlike managed-care plans that limit beneficiaries to networks of doctors, fee-for-service plans advertise that seniors can go to any doctor who agrees to the plan's terms.
But, Ms. Taff said, some older adults find out after they sign up that they can't see the doctors they've had in original Medicare.
"They're either being misled or misunderstanding what they're told," she said. "Before joining a plan, make sure your doctor accepts it."
Experts say private Medicare plans offer seniors an alternative to original Medicare. But they can be bewildering.
The number of Advantage plans has doubled or tripled in many areas over the last year. Thirty-eight plans are available in Dallas County.
"Some seniors don't know what questions to ask and buy something they don't want," said Ron Austin, a social worker with Baylor Health Care System.
Ms. Taff said some sales agents play up the dental or vision care and gloss over the plans' drawbacks.
Big letdown
Merlin Jones, 67, of Dallas said he thought he was helping his wife, Ruby, get prescription drug coverage when he enrolled her in a private plan.
Then he found out that home health services would be cut off for his 65-year-old wife, who suffers from Alzheimer's disease.
The drug coverage also turned out to be an empty promise.
"After I bought the one plan, I was told I'd have to wait until November to sign up for another that covered drugs," Mr. Jones said.
"Insurers should make sure people understand what they're buying," he said.
"Why do they put us through all this?"
Sales tactics
The Senior Source is helping older adults disenroll from Advantage plans if they think they've been duped.
Those seniors can return to original Medicare within about a month, Ms. Taff said.
The Texas Insurance Department is also hearing from older adults about shoddy tactics by plans' sales agents.
"Some of the tactics, such as door-to-door marketing, clearly violate the law," said department official Norma Almanza.
Ms. Hubbard said she bought her private Medicare coverage from a woman who came to her house uninvited.
"The saleslady was knocking on every door in the neighborhood," she said.
Bennie Dixon, who's 77 and lives in Dallas, said two sales agents approached her and her sister while they were shopping at a discount store.
"They weren't connected with the store. They just walked up behind us in the aisle and started making their pitch," she said.
Medicare's marketing rules forbid such solicitation, said Art Pagan, an official in Medicare's Dallas office who helps regulate the Advantage plans.
Though most insurers contract with independent agents, they're still responsible for any inappropriate sales tactics, he said.
Ms. Almanza said some seniors are confused about what they're buying because some agents are confused about what they're selling.
"Some agents don't realize the problems they're creating for clients," she said. "But that's no excuse for what they're doing."
WellCare Health Plans Inc., which sold Ms. Hubbard her plan, said its agents have to complete an online training course and pass a test.
John Aberg, vice president of corporate communications, said the company knows of no problems with the sale of its private fee-for-service plans in Dallas.
"We have rigorous compliance standards for the independent agents who sell our products," he said.
"We consistently monitor sales practices for potential issues and educate or even terminate brokers based on our findings."
Call for help
To curb overzealous marketing, some insurers have begun withholding sales commissions for 90 days while they make sure new customers are satisfied with their coverage, Mr. Pagan said.
Medicare will investigate seniors' complaints about Advantage plans and, if verified, work to resolve the problems, he said.
Anyone who's had difficulty with a plan should call Medicare at toll-free 1-800-633-4227 or the Area Agency on Aging at 211, Mr. Pagan said.
Advocates for older adults say it's hard to determine the extent of the problems with the private fee-for-service plans.
The Senior Source says it has heard from about 25 seniors over the last month.
The state Insurance Department says it gets calls daily.
Time to switch
Ms. Almanza expects the complaints to increase, even though the annual open enrollment period for Advantage plans ended on March 31.
A new federal law allows seniors to switch at any time in 2007 or 2008 from original Medicare to an Advantage plan as long as it doesn't include drug coverage.
"Anyone who's approached about a private Medicare plan needs to ask questions because sales agents aren't always telling the full story," Ms. Taff said.