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Medicare Guide 2023: Complaints soar over misleading Medicare Advantage marketing; how to protect yourself

They’re the TV stars of a bygone era, a heroic quarterback, a starship captain and a sitcom sensation.

Joe Namath, William Shatner and Jimmie JJ Walker have been back on TV screens in recent years, working as pitchmen and urging older viewers to call in to see if they are eligible for extra Medicare benefits and bigger Social Security payments.

Consumer watches say the commercials are grossly misleading, making promises the company behind them often can’t deliver. The ads – and similar marketing pitches – have coincided with a spike in complaints about Medicare Advantage marketing, which surged 165% last year.

Medicare Advantage plans provide health insurance through a private insurer instead of from the government, bundling together preventative care, hospitalization coverage and typically including prescription drug benefits, too. Federal authorities imposed new rules on marketing this year designed to crack down on misleading claims by making advertisers disclose that certain Medicare Advantage plans may not be available everywhere and requiring that they record certain sales calls.

Advocates for Medicare beneficiaries and members of Congress say more is needed. They blame insurance companies backed by private equity funds that they say are trying to win Medicare Advantage clients with advertising bluster instead of better insurance plans.

“The insurance companies are always trying to come up with new ways to trick seniors, dupe them into buying their product,” said US Sen. Ron Wyden, D-Oregon.

Misleading TV ads are just one of many risks Medicare beneficiaries face this time of year. There’s a separate threat from would-be fraudsters who try to take advantage of the open enrollment period that runs through Dec. 7 to trick consumers into signing up for services that could prove expensive or to steal their Medicare number.

“Medicare fraud is extremely rampant because it’s pretty easy to pull off, sadly,” warns Kathy Stokes, director of fraud prevention with AARP.

Scammers can use pilfered Medicare numbers to submit sham bills or they can dupe beneficiaries into ordering expensive equipment that doesn’t meet their needs and may not be fully covered by their plans.

So Stokes and other consumer advocates encourage Medicare beneficiaries to be extremely cautious about responding to mailers and advertisements they see on TV and online, and to never share Medicare numbers with anyone but their health care provider or insurance company.

“They’re so good at making their pitch look like it’s coming from Medicare or a legitimate Medicare affiliate,” Stokes said.

If you think you’ve shared your Medicare number with someone you shouldn’t have, or have been lured into signing up for a Medicare Advantage plan you didn’t really want, notify Medicare right away.

And if you have questions about whether a plan is legitimate, or need help figuring out what’s real and what’s a scam, contact your State Health Insurance Assistance Program (SHIP) for assistance. (In Oregon, it’s called SHIBA.)

“They can direct you to someone that can actually help you,” Stokes said.

Tigard Medicare insurance broker Lisa Lettenmaier said she’s always had calls about the commercial clients see on TV, but she said last year was especially egregious.

“I spent a lot of time having the same conversation with my clients saying, ‘Yeah, it’s too good to be true,’ ” Lettenmaier said.

Some TV ads made blanket promises that really apply only to a small subset of beneficiaries, she said. Other clients received mailers designed to look official using urgent phrases like “second notice” and “final notice” in hopes of luring in beneficiaries. If seniors respond by asking for more information, Lettenmaier said marketers interpret that as an invitation to keep pressing them to sign up for their plans.

“When you’re getting cold calls, when you’re getting mailers, just be really aware of what it is,” she said.

Last summer, Wyden sent a letter to state insurance agencies across the country seeking data about false or misleading advertising. It’s information the senator plans to use to press federal regulators to implement stronger consumer protections.

“Bad actors keep finding ways to milk the program, make a quick buck off the vulnerable,” Wyden said. “So I believe the data’s going to confirm this question of deceptive marketing and these numbers that show the number of complaints going up are accurate.”

The goal, Wyden said, is to create a marketplace for Medicare Advantage that rewards insurance companies that deal honestly with consumers and offer plans that provide genuine value.

“If you can get a good reputation in the senior community that’s very beneficial to you economically. So there are plans that are trying to do good and do well,” Wyden said. “But I think bad actors always need to be weeded out.”

Tips for avoiding Medicare scams

Advice from Medicare, the Oregon Department of Human Services and AARP.

  • Protect your Medicare number and Medicare card. Don’t share them with anyone but your health care provider or Medicare Advantage plan. You don’t need to provide your Medicare number to receive information about plans.
  • Beware advertisements for free services or products in exchange for your Medicare number and cold-calls from people who claim to be from Medicare and want your number.
  • Scrutinize your Medicare Summary Notice to ensure the listed health claims are legitimate.
  • If you’re shopping for a plan based on a TV ad or a mailer, check with Medicare Plan Finder at Medicare.gov to ensure it’s a legitimate plan.
  • Report suspected scams to Medicare at 800-633-4227, or 877-772-3379 for Medicare Part D prescription drug issues.
  • Contact your State Health Insurance Assistance Program (SHIP) for help navigating legitimate Medicare Advantage plans.
  • Contact the AARP’s Fraud Watch Network at 877-908-3360 if you think you’ve been a victim of fraud or need help identifying whether an offer is legitimate.

— Mike Rogoway | mrogoway@oregonian.com

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