Medicare Scams
About 44 million Americans are Medicare beneficiaries. About 80% are now receiving health care services through the traditional Medicare program according to the Alliance for Retired Persons. The rest of Americans, about one in five (8.7 million) receive care through Medicare Advantage (MA) plans.
MA plans have nothing to do with regular Medicare. They are NOT considered to be supplement plans. They are private-fee-for-service plans.MA plans are an 80% plan and the rest (about 20%) is out of pocket for the consumer. They have a cheap premium of $ 0.00 to start off with.
Regular Medicare plans have a $93.50 premium and can only be adjusted with COLAS (cost of living adjustments) once a year. MA plans, the private-fee-for-service or PFFS plans, are overpaid as much as 19 percent and are exempt from many legislative and regulatory requirements imposed on other MA plans by our government.
Remember that any of the Medicare Advantage plans other than the traditional Medicare plan have nothing to do with Medicare itself.
The 110th Congress decided to put MA plans into effect after exploring other plan options and found that managed care was not working as they had hoped. These plans cost more than Medicare plans to operate. As a matter of fact, if these plans were not in effect, Medicare would be a lot cheaper.
MEDICARE DOES NOT WRITE LETTERS TO ANYONE. What I have found in pursuing Medicare Advantage plans is:
* Your cost may be greater than traditional Medicare
* There is no guarantee that the plans offer more than Medicare offers.
* You may not get emergency or other care when you need it.
* Your doctor may not be in the plan or accept it.
* You have little protection from fraudulent marketing.
* MA plans change from year to year.
* MA plans may withdraw altogether.
* You cannot use your red, white and blue Medicare card if you sign on to the MA plan. You must use theirs.
* You are taken out of the Medicare system although you remain if you change your mind on the MA plan.
* The MA plans are not supplement policies. They are equivalent but not equal to the normal Medicare 80% plan.
* You know the reliability of Medicare not the MA plans.
Medicare is the most proven and reliable way to go. It is always there for you and you know what to expect from Medicare. These MA plans will NOT guarantee you anything except the fact they will take your money whenever and wherever their rule applies and yet they may drop you altogether.
I have been told by the experts that CMS in Charlotte accepts very little if any of these plans, Baptist Hospital in Winston-Salem does not accept hardly any of these plans and so on with these larger hospitals. One county does not accept these plans period. The whole point is if you have an arm injury and you need to see the doctors, chances are they will accept this plan. But if you have a knee injury by the same patient, chances are they will not accept the plan. Payment of an injury is decided by what is wrong with you. What you think they may pay they will NOT.
According to what we have been told, the MA plans cannot knock on your door. After much litigation in the court system, these MA plans can only respond to the consumer. They cannot pursue you. But it is happening!
These MA plan reps are working in our state as well as the nation by ignoring the court ruling. They are telling people their plans are supplements to Medicare. They are NOT supplement plans. North Carolina has implemented a way to help you if you get caught in these schemes. It's called the Seniors'Health Insurance Information Program, NC Department of Insurance run by the Commissioner Jim Long.
Once you enroll in one of these plans, you have a hard time getting out of them if you cannot afford up front fees for services. If you feel the MA plan representative did not tell you everything and left you with a lot of questions tell someone. Then I want you to call SHIIP (Seniors' Health Insurance Information Program- www.ncshiip.com) in Raleigh. Tell them what has happen and they will direct you to the right person to talk too. Their number is 1-800-443-9354. If for some reason you can't find the number when you need it, remember
1-800-Jim Long.
Folks, this is very serious business and a lot of seniors are getting caught up in these scams. DON'T GIVE UP YOUR RED, WHITE AND BLUE MEDICARE CARD FOR ANY OF THESE PLANS. That card is the most precious thing you own. It will save your life.
Shirley Wiggins
NC Senior Dems
Special Legislative Action Committee Chair
Barbara Tetterton
Legislative Committee Chair