On November 19 2010 Universal American was essentially told to take a time out for bad behavior by the Centers For Medicare And Medicaid Services. Beginning December 5 2010 Universal American had to cease marketing and enrollment activities for their Medicare Advantage plans. The Community CCRx PDP plans are not effected and will continue to be available for those who would like to enroll.
Approximately 300,000 Medicare beneficiaries are enrolled in a UA Medicare Advantage plans which are offered in all fifty States and the District Of Columbia. Current members and members who had enrolled for 2011 were not affected.
Why UA Medicare Advantage plans?
When CMS sanctions a provider of Medicare Advantage plans it does not necessarily mean there is a problem with the plan itself. In fact, in the case of UA medicare plans, it is not the plans being offered but rather those who were offering the plans that are the problem.
The sponsor of the plan was sanctioned because there was not proper oversight of agents offering the plan to prospective members. Agents were misrepresenting the plan’s provider network and the plan’s Part D formulary. These misrepresentations may have resulted in delays to patients receiving treatment and potentially putting their health at risk.
Insurers contracted with CMS to offer Medicare Advantage and Medicare Part D plans must educate, test and certify agents who plan to represent the company’s individual Medicare products on an annual basis. In addition, they must provide appropriate oversight of agent’s marketing activities.
Universal American had to honor their commitment to all plan members even though they were not able to enroll new members.
Protect yourself – know the enrollment guidelines
There are certain Medicare Advantage enrollment guidelines that you should be aware of to protect yourself from any agent that is less than honest. Now, let me point out that the majority of insurance agents are decent business people following the rules and only trying to provide for their families. But every profession has some bad apples.
There are certain behaviors that agents cannot engage in when marketing or presenting Medicare Advantage and Part D plans. Here are some things agents cannot do:
- Cold call you on the telephone.
- Visit you at your home uninvited.
- Call referrals you may give them.
- Approach you in parking lots, buildings or other common areas.
- Give you a gift valued at more than $15.
- Offer you a gift to submit an application.
- Present other products at the Medicare appointment.
Agents must also have you complete a Sales Scope of Appointment form, granting them permission to speak to you about the products you are interested in.
Once Universal American demonstrated that they had corrected the problem, new enrollment could resume. Universal American is not the only company that has been sanctioned by CMS and corrected their mistakes. Once sanctions are lifted you should be able to consider their plans again.