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— Regulators clamped down last fall on shady sales practices for privately run Medicare health insurance for the elderly.
New regulations for the plans, known as Medicare Advantage, banned unsolicited phone calls and door-to-door sales. They stopped agents from churning up commissions by switching customers to new policies. Meals tied to marketing activities also are now forbidden.
But customers and advocate groups say the plans' confusing nature still leaves room for pitches bordering on the deceptive, and abuses still crop up.
Seniors report being pressured with unsolicited phone calls or home visits that are clearly prohibited. Some have signed up for plans that didn't include their longtime doctors or hit them with unexpected costs, things they learn weeks later.
"I think the real issue is that people are not getting what they thought they would be getting," said Vicki Gottlich, senior policy attorney for the Connecticut-based Center for Medicare Advocacy.
Medicare Advantage plans are privately run versions of the government's Medicare program, which provides health coverage for the elderly and disabled. The government subsidizes these plans, and the industry has developed what can be a mind-numbing array of them.
The plans offer basic Medicare coverage topped with extras or premiums lower than Medicare's standard monthly rate of about $96.
Private fee-for-service plans, which don't involve doctor networks, are frequent complaint targets, said David Lipschutz, an attorney with the nonprofit California Health Advocates.
"The plans are pitched as allowing you to see any doctor you want, which is only half true," he said. "The doctor has to accept it."
Wichita, Kan., resident Willa Conners had no interest in leaving her Medicare Advantage plan when an agent made an unsolicited call to her earlier this year.
But Conners, 69, said the agent — whom she declined to name — offered a new Medicare Advantage plan with no monthly premium. He then pressured her to decide during a home visit in March.
She thought the new deal might make things easier financially, so she signed up. Conners' husband, Robert, suffered a stroke and lives in a nursing home.
But she learned her doctor of 28 years wouldn't take the new plan. It increased her payments for doctors visits and medicines. It also exposed her to big hospital bills. Conners quickly returned to her old plan.
"I felt so dumb," she said.
The new marketing rules have helped, but they don't go far enough, according to Lipschutz, the California Health Advocates attorney. He thinks CMS doesn't have enough staff to police the country for marketing misdeeds, and he wants state regulators to become more involved.
CMS spokesman Peter Ashkenaz said in an e-mail his agency has made "significant progress" in catching troublemakers.
CMS monitors insurance marketing events and advertising and checks on call center pitches. The agency did more than 1,000 undercover visits to marketing events across the country during the last enrollment season.
CMS learns every year about areas that need more vigilance, said Timothy Hill, deputy director for the Center for Drug and Health Plan Choice. He noted that sales agents used to operate in a "wild, wild West" environment where they could maximize commissions however they wanted, but that's changed.
"There's 10 million people and hundreds of plans," he said. "You're always going to have issues. "We just hope they're not as acute as we had seen over time."
