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Enrollees, Beware: Medicare Sign-Up Is Near; So Are Sales Agents

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By CAROL GENTRY / Tampa Tribune

Published: November 10, 2007

At the Acorn Trace apartment complex in Tampa, the elderly and disabled residents are bracing as if for a siege. They've organized patrols to guard the door and quiz strangers.

What's the threat? The 2008 enrollment season for Medicare drug and health plans starts Thursday.

Last year, manager Barbara Van Matre says, sales agents made aggressive moves on her residents, enrolling them in plans that sometimes met their needs but more often didn't. When that happened, she said, it took her months to pry them loose. "I'm very concerned that when the 15th hits, we're going to be right back in the mess we were in before," Van Matre said. "The [agents] can talk these folks into anything."

As many Medicare beneficiaries have learned, getting out of a plan is a lot harder than getting in. It's as though they are trapped in the Medicare computer.

The online system at www.medicare.govstill shows Carol Paremske as being in the wrong plan, she says, even though she has called and written many times to both the plan and the government over the past 10 months.

"Medicare did nothing for me," she said. "Every time I called, they referred me right back to the plan."

From now until March 31, Medicare beneficiaries are the most popular demographic in town for insurers, since each of them can, by simply signing their name, add $8,000 or more in taxpayers' money to the company's revenues next year. Commissions for enrolling beneficiaries in what the government calls a Medicare Advantage plan run to hundreds of dollars.

While enrollment for a prescription-drug plan ends Dec. 31, the Medicare replacement plans can sign up members any time through March 31, when the lock-in period for 2008 commences.

After that, members can only escape from the wrong plan if they persuade the Centers for Medicare and Medicaid Services (CMS) they were tricked into enrolling or aren't receiving proper care. It requires energy and advocacy skills that many beneficiaries lack, so consumer advocates are warning beneficiaries that it's Medicare-beware time.

According to testimony before Congressional committees in May and June, sales agents for some companies enrolled many people who did not know what they were signing - even some who had died.

Companies accused of marketing abuses included Tampa-based Health Plans Inc., UnitedHealthcare's Secure Horizons, one of the nation's largest Medicare insurers, and Humana, a top Medicare insurer in Florida. The companies said they now have reforms in place, such as training for agents, spies at sales seminars to monitor sales pitches and calls to enrollees to make sure they understand the coverage.

CMS has agreed to allow almost all the companies that got into trouble last year to resume marketing and enrolling. An exception is the Any, Any, Any plan sponsored by Universal Health Care Insurance Co.

CMS official Abby Block said it may only re-enroll existing members until it receives clearance from Florida insurance authorities, which placed it under supervision earlier this year.

To be sure, many beneficiaries who enroll in Medicare Advantage plans find them a terrific deal, covering not only medical and hospital bills and prescriptions but also extras, such as gym memberships and sometimes eyeglasses.

There are two basic kinds: the ones with medical networks that members must stay within, such as HMOs and PPOs. The other kind is a private fee-for-service plan, which covers care anywhere as long as the doctor or hospital agrees up-front to accept it.

Jeannie Fantle of Tampa, who signed up last year for Any, Any, Any, said it can be difficult sometimes to find a doctor who will accept it. In those cases, she said, she pays for the visit and gets reimbursed later by the company.

She loves the savings, $200 a month less than what she paid for a supplement plan when she was on traditional Medicare. "I'm ahead of the game," she said.

Those who wind up in the wrong plan, though, say it's like being caught in a trap. Carole Hammac of Acorn Trace, whom the government automatically enrolled in a plan that she didn't want, said it felt like "prison."

Another resident, Alvada Forbes, said she couldn't get through to the plan she was first on without a tedious wait on the phone, one time five hours. "I like to went crazy," she said.

Theoretically, the plans and the Medicare call center are supposed to help, but many beneficiaries and advocates for the elderly report that some call-center workers don't make much of an effort - assuming you can get through.

When one Acorn Trace resident somehow got enrolled in a WellCare plan while signing up for low-income assistance, Van Matre said, it took months to get her out.

"We made phone calls [to the plan and Medicare], we faxed letters - nothing worked," Van Matre said. It took intervention from the office of U.S. Rep. Kathy Castor, D-Fla., she said.

WellCare spokeswoman Amy Knapp, responding to Tribune questions about this case, said the company can't discuss specific members because of federal privacy laws. She said WellCare follows the CMS rules that govern when and how members enter and leave plans.

Castor, who visited Acorn Trace last week to talk with residents, told the Tribune that plans may delay responding to complaints of improper enrollments so that they can collect government premiums as long as possible.

She said CMS may be making double premium payments for the same beneficiary. "It's hard to know because CMS won't do the audits," she said. A July Government Accountability Office report said CMS hadn't audited at least a third of Medicare Advantage plans as required. CMS said it lacked resources.

Castor advised residents to check on changes in their plans, since companies may be raising prices and revising the list of drugs - the formulary - they cover. If they aren't computer-savvy, she said, they need help from someone who is, because the system is complicated. "You need independent advice," she stressed. "Be very cautious when these insurance folks approach. Your doctor may not be on their plan."

Independent advice is available from the state-sponsored SHINE (Serving Health Insurance Needs of Elders), advocates say. For information, call 1-800-96ELDER (1-800- 963-5337) or e-mail information@elderaffairs.org.

Reporter Carol Gentry can be reached at (813) 259-7624 or cgentry@tampatrib.com.

Confusion Is The Side Effect

Charleen Edge, a retired hospital social worker, understands insurance and still has her wits about her. But even she got trapped in the wrong plan.

In July, the 78-year-old St. Petersburg woman and her son, Joseph Saunders, a lawyer, filed a lawsuit against UnitedHealthcare of Florida, alleging an agent for the company enrolled her in a Medicare Advantage plan when Edge thought she was signing up for the drug plan co-sponsored by AARP and United.

"I never intended to give up my Medicare," she said.

She tried to get things straightened out with calls and letters but wound up with no coverage when she broke her hip in April 2006, running up $30,000 in unpaid bills. Saunders said he, too, wasted months trying to unravel the red tape. Finally, he sued.

Last month, United settled the case, agreeing to pay Edge's medical bills and refund her drug-plan premiums. The attorney for United, Christopher Pace, said confusion is a side effect of the Medicare system, which pays private companies to offer competing plans. "With choice comes complexity," he said.

Saunders thinks Medicare has overdone it: "It's absurdly complicated."

The Computer Must Be Right

When Louise Bradley of Tampa called a medical-supply company two months ago to order husband Richard's diabetes supplies, she ran into the same trap she has been fighting for two years.

The supply company's employees said Medicare's online information listed Richard Bradley as a member of a WellCare HMO. Since they didn't have a contract with WellCare, they said, they couldn't fill the order.

Louise Bradley told them her husband has not been a WellCare enrollee for two years; he's in a Universal Health Care plan. They said they had to go by what the computer said.

"This is driving me crazy," Louise Bradley told the Tribune.

It's not clear whether WellCare, Universal or Medicare is responsible for the mistake, but Louise Bradley said she has put the complaint in writing to all three and called repeatedly. She's fed up.

"I'm an 84-year-old woman with a limited education. I don't have a computer. I'm doing the work [they are] supposed to do, and I'm not getting paid," she said.

The government cited WellCare in August for, among other things, failing to track the status of members, which kept beneficiaries from getting their services covered. The company was ordered to correct that.

'They've Lost Track Of Me'

Carol Paremske of South Tampa decided last December that she could save money if she switched drug plans.

She went to the Webs ite www.Medicare.govon Dec. 2 and told the computer to switch her from the AARP/United plan to WellCare Complete. But when the enrollment hadn't gone through by the end of the month, she decided to remain in the AARP plan.

All year, she has paid premiums to AARP and the plan has covered her drugs. The problem, Paremske said, is the government and WellCare think she's still enrolled there. WellCare even sent her an ID card, albeit for a different plan than the one she had originally signed up for.

Paremske keeps a lengthy log of all her calls and copies of her letters. She has faxed forms and filed complaints. Nothing works.

"I have high blood pressure and at times, I'm ready to blow my top over this," Paremske said. "How dare they do this to me?"

She thought the dual-enrollment problem was resolved in June, when WellCare stopped sending dunning notices. But, no; in September, the company sent her a form saying it couldn't "disenroll" her. Last week she received a WellCare renewal notice for 2008 and a bill for $160.20.

The 1-800-MEDICARE operators still tell her, every time she checks, that she's enrolled in WellCare, and no amount of arguing works. When she goes to the Medicare Web site, it lists her as a member of WellCare.

"They've lost track of me," Paremske said. "There's nobody in control."

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