Trapped In The Private Medicare Maze

If You Get Roped In By A Commission-Seeking Salesperson, It's Not Easy To Get Out

(CBS)  Last night we told you how a large part of the Medicare program is now privately run by insurance companies — and how confusing and costly that private coverage can be for some senior citizens. Tonight we take a hard look at how far some insurance agents will go to sign up new customers for their private Medicare plans.

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Seventy-four-year-old T.W. Aldridge of Mississippi woke up one day to discover he'd suddenly been switched from the government-run Medicare to a private Medicare Advantage plan. A con artist insurance salesman had forged his signature in order to collect a $300 commission, putting an ailing Aldridge in a plan his son says his doctors would not accept, CBS News chief investigative correspondent Armen Keteyian reports.

"He told the doctor 'I can't go to the hospital. I don't even have insurance, they got me so fouled up,'" said T.W.'s son, Mark Aldridge.

A CBS News investigation has found Medicare Advantage has become a costly disadvantage for tens of thousands of seniors who unknowingly wind up on a private plans they don't want or need, hooked by unscrupulous salesman.

At the Medicare Rights Center, complaints pour in daily about tactics used by some of the 200,000 agents pushing private Medicare plans nationwide.

"Insurance companies are doing very well quarter by quarter thanks to these programs," says the center's Robert Hayes. "Brokers, who are often pretty much unregulated in most parts of the country are going around, working on high commissions."

To date, 43 states have received complaints about people being coerced or conned into private Medicare plans. The complaints include forged signatures, identity theft, lying about coverage and illegal high-pressure door-to-door sales tactics.

Leslie Norwalk, the head of Medicare, says her agency is cracking down on deceptive sales practices.

Keteyian told her: "We got a woman in Kentucky who had to call 9-1-1 to get the salesman out of her house. We have another case where agents are signing up dead people in Georgia. We have another case in Mississippi where 100 people whose IDs were stolen, they turned up on Medicare Advantage. I mean, when you hear things like that..."

"I'm glad that we have such competent law enforcement partners and that we work together with them as soon as we hear of these things," Norwalk said.

CBS News has learned that, overall, at least 36,000 seniors have pulled out of their private Medicare plans in just the first four months of this year. And nearly 100 private plans have been ordered by Medicare to change the way they do business.

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Read Part I of the investigation.
Find resources for navigating private Medicare.
Read about the Senate Special Committee on Aging's investigation into deceptive sales practices.

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Like so many others, T.W. Aldridge tried to get off Medicare Advantage through months of phone calls and letters to Medicare and the private plan. He finally did. Ironically, it was 11 days after he died last August.

"The last thing that he said was 'take care of your mom, make sure you take care of those bills. Don't leave all those on her,'" his son said.

Forty thousand dollars in bills that remain a family burden — bills that Medicare has yet to pay.

[sochi201]

I am an insurance agent. I own an agency that supports 28 agents in Colorado marketing the new Medicare plans. You need the good story about insurance agents now that you have blasted us and made us look like criminals. You need my story and the story of the 2000 seniors who do business with my agency. You also need to know that the insurance company that contracted your crooks that you reported on are the primary source of the blame for the problems you are reporting. The insurance company makes more money that the agent and the insurance company contracts crooks. Then you want to blame hard working people like my agents for the fault of an insurance company, Humana for one, that does not police the contracts they offer. Your story is about 1% of the truth. If you want the truth you call me at 970-468-7884, or, e.mail me at [e-mail]. I am here and I have the truth. Your news plays on bull *** like what you have written and you have reported on 1% of the issue.

[hark551]

contact medicarerights.org they will help with medicare disadvantage programs problems

[kmay1967]

I have called medicare 3xs per week for the last 3 months and still haven't received help for the 26 Advantage plans that I have been appealing - our local doctors and hospitals will not accept the Advantage plans either - strictly because they tell them when how & why they should doctor their patients - I have had some success contacting local congressman - and also the media - as much knowledge as we can get out to the population - and it isn't just our seniors it is also our disabled population which have even more health issues and rx needs that can be affected by these advantage plans. If you can find an email address to CMS complaint department sometimes that helps also. Just keep trying!!! Sometimes we are all that these people have to help fight for their rights!

[hark551]

This is my second comment on Medicare Advantage plans and Medicare. In May of this year I received a call from one of my medicare supplement policy holders son. His 91 year old father was enrolled on the any any plan and was told it was free and would help with his drug cost. He was not told that he would be taken off original medicare and that his supplement would no longer pay. Guess what he needs an operation and his Dr. nor hospital will accept his any any plan. On June 1st his son and I contacted Medicare through a special election period he was to be back on Medicare 7/1/07.. He is still not and still needs operation. I ahve spoken with Medicare at least 10 times to no avail. What to do????

[kmay1967]

I have been working as an advocate, for the past 2 years with this nightmare Medicare Part D and also the fallout of insurance sales people who bully and manipulate the elder population with their so called wonderful Medicare Advantage Plans - what is not being mentioned is these companies no longer have to follow the guidelines for medicare covered procedures - they choose what they feel is medically necessary - and also try to tell the doctors how to and when to hospitalize paitents - I am working right now with a lady who spent 10 days in the hospital due to kidney failure caused by medication complications and her wonderful Advantage Plan determined her stay not medically necessary and they will not pay bills that are now exceeding $85,000 - her health is deteriorating due to this stress - she can not pay this amount - and has absoultely no idea how she was enrolled in this plan - and also they try to make the plans sound so much less expensive - you are still paying Medicare out of your social security check but your rights to Medicare services have been taken away by these unscrupulous plans - Yes Medicare is overseeing this, and complaint after complaint has been filed with no help in sight!!! Our government should be ashamed of what they have done to our seniors!!!

[dbrook3]

I am a home health nurse in Southeast Texas. My agency & others like us who take care of Medicare clients, daily & sometimes up to 4x a day have seen an increase in the number of Medicare Advantage signups without the client's knowledge. Sometimes they are told that it is a supplemental plan, a new and cheaper drug plan. When they get their packet form the new insurance, it is to find that their traditional Medicare has been discontinued, often along with their Part D prescription plan and they are lost, confused, angry &* often without coverage from either plan. I am so glad to see CBS take an active role in this investigation. I have filed complaints for several of my clients and I am getting that the Texas Board of Insurance, nor MEdicare can do anything about this. We have laws against fraud & abuse to the point of losing our Medicare & State liscensure. Shouldn't these insurance companies be held to the same standard?

[skyk-2009]

Some one has got to step up to the plate here folks, this is VERY ugly and yet another rip off of the American Tax Payers. We have the most expensive health care system in the world there can be no debate about that. That system cares for LESS people for the cost than any system in the world. Now anyone with a brain should be able to see that we are NOT getting what we are paying for. By the same token those who listen to propaganda put out by those who are robbing us are being very stupid. Time to change this system, time to look around at the other nations out there, see what they are doing and see if we can take that and improve on it. Trash is the best place for what we have.... We can not afford it anymore.

[zyreeta318]

This story was not supplied accurately. Medicare Advantage plans hav very low cost premiums ($0-$50)to assist medicare beneficiaries w/high out of pocket cost associated with Original Medicare, especially when Medicare Supplements are mostly affordable. Medicare premiums cost seniors $93.50 monthly and it is automatically drafted from their social security income. People do well to examine pages 105-106 in the 2007 Medicare & You book to compare the cost of Original Care with Medicare Advantage Plans. Part A under medicare immediately charges the beneficiary $992 when admitted to the hospital and it only pays for room/board. The medical procedures are covered under Part B but after $131 annual deductible is met and then charged %20 of Medicare's Approved charges, plus %15 EXCESS charges that the doctors/hospitals have the right to bill the patient. The nations seniors cant afford this health care cost and M A plans (also called Part C) were designed to help seniors defuse the high cost of Original Medicare. And to correct Ms. Keteyian's research, there is no more $ paid to private insurance companies for administering Medicare benefits and it doesnt cost tax payers more -In fact, the cost is less. The private companies absorb any additional cost outside of Medicare and allow for extra benefits and services. Private Fee For Services companies and HMO companies are different and shouldnt be addressed as being in the same category!

[erasmus6]

I think you Americans need to start looking outside your country to see what universal or socialized healthcare is REALLY about not what you have been brain washed into thinking it is.
Do some research.

You have an election coming up and you need to think long and hard about who you are voting in. First off though, you need to change your voting system, the one you have now is too easy to manipulate by corrupt people.