State warns of Medicare marketing scams
October 14, 2011 11:31am
• Swindlers gearing up for open enrollmentt peruiod
• ‘There are a few bad actors just waiting to take advantage of another unsuspecting senior’
California seniors and their advocates should be on guard against unreasonable sales practices during the annual enrollment period for Medicare Advantage plans and the Medicare Prescription Drug Program. Open enrollment runs from Oct. 15 through Dec. 7, says state Insurance Commissioner Dave Jones.
“California seniors and their families should be extremely cautious when they are approached by aggressive agents selling products that sound too good to be true,” says Mr. Jones. “While the majority of agents are honest and have good intentions, there are a few bad actors just waiting to take advantage of another unsuspecting senior.”
Mr. Jones says the state will vigorously investigate suspected scams involving seniors.
He offers some tips:
• Remember that Medicare has no official sales representatives so the program doesn’t send people to solicit your business.
• Federal regulations prohibit unsolicited sales call, and marketing in educational or care settings.
• Guard personal information. Never give out Social Security numbers, bank account numbers, or credit card information over the telephone.
• Verify that the person you are dealing with has a proper authority to act on behalf of the plan.
• Federal regulations also prohibit offers of free meals for listening to a sales presentation or for signing up in a particular plan.
“If we know about questionable conduct, we can do something about it,” says Mr. Jones.
Sutter Health to be exclusive network care provider for $0-premium AARP
Through a unique and exclusive relationship with Sutter Health in Northern
California, UnitedHealthcare has introduced a new Medicare Advantage plan to the
more than 280,000 Medicare beneficiaries in the greater Sacramento and foothill
This latest addition to UnitedHealthcare’s portfolio of Medicare plans
available in the Sacramento area offers beneficiaries benefits, cost-savings and
comprehensive coverage exclusively at Sutter Health-affiliated medical
Sutter Health will be the exclusive network care provider for beneficiaries
who enroll in the new plan, AARP MedicareComplete insured through
UnitedHealthcare (AARP MedicareComplete SecureHorizons Plan 2 [HMO]). Members
will have access to comprehensive care available at Sutter’s extensive hospital
and physician network in the greater Sacramento area. The hospitals include
Sutter Auburn Faith Hospital; Sutter Davis Hospital; Sutter Medical Center,
Sacramento (composed of Sutter General and Sutter Memorial hospitals); and
Sutter Roseville Medical Center. Sutter’s physician network includes two
affiliated physician groups, Sutter Medical Group and Sutter Independent
Physicians, totaling more than 1,100 physicians. Members also can access
outpatient care including lab, X-ray and physical therapy services at Sutter’s
health ancillary facilities.
Medicare beneficiaries who enroll in this new plan will be able to:
– receive Part D prescription drug coverage at no additional monthly premium
beyond the Medicare Part B premium;
– visit Sutter’s primary care physicians and specialists for low
– access Medicare-covered preventive care and screening exams for no
– add vision and dental coverage for an additional monthly premium.
UnitedHealthcare is the nation’s largest company dedicated to meeting the
health and well-being needs of seniors and other Medicare beneficiaries.
Approximately 9 million members are enrolled in the business’s portfolio of
Medicare plans, which includes Medicare Advantage, Part D prescription drug and
Medicare supplement plans. UnitedHealthcare has offered Medicare plans in
California for more than two decades and currently serves more than 320,000
Medicare beneficiaries in the state, including more than 15,000 in the greater
“We look forward to providing enhanced value and quality coverage through
this unique relationship with a health system as reputable as Sutter,” said Josh
Martin, executive director of UnitedHealthcare Medicare & Retirement in
Northern California. “UnitedHealthcare’s AARP MedicareComplete plan is an ideal
choice for many beneficiaries, one that will allow them to access prescription
drugs and the health-care services they need from a trusted and highly regarded
health-care system, all for a $0 monthly premium.”
Sutter Health is one of the nation’s leading not-for-profit networks of
community-based health care providers, delivering high-quality care in more than
100 Northern California communities. Sutter Health supports more than two dozen
locally run acute care hospitals, as well as physician organizations, medical
research facilities, home health, hospice and occupational health networks, and
long-term care centers.
“This is the latest example of our network’s broad efforts to transform how
we deliver our services, while ensuring that high-quality health care is both
accessible and more affordable for our patients and communities,” said Sarah
Krevans, regional president for Sutter Health.
Medicare beneficiaries living in Sacramento, Placer and Yolo counties can
enroll in the AARP MedicareComplete plan during the Annual Election Period (Oct.
15 — Dec. 7). For more information about this new plan as well as the other
Medicare plans UnitedHealthcare offers in the Sacramento area, visit
About UnitedHealthcare UnitedHealthcare is dedicated to helping people
nationwide live healthier lives by simplifying the health care experience,
meeting consumer health and wellness needs, and sustaining trusted relationships
with care providers. The company offers the full spectrum of health benefit
programs for individuals, employers and Medicare and Medicaid beneficiaries, and
contracts directly with more than 650,000 physicians and care professionals and
5,000 hospitals nationwide. UnitedHealthcare serves more than 38 million people
and is one of the businesses of UnitedHealth Group /quotes/zigman/258846/quotes/nls/unh UNH
+1.48% , a
diversified Fortune 50 health and well-being company.
About Sutter Health Sacramento Sierra Region Sutter Health’s Sacramento
Sierra Region encompasses hospitals, physicians and outpatient centers in
Amador, El Dorado, Placer, Nevada, Sacramento, Solano, Sutter, Yolo and Yuba
counties. It is a part of the Sutter Health family of not-for-profit hospitals
and physician organizations that share resources and expertise to advance
healthcare quality. Serving more than 100 communities in Northern California,
Sutter Health is a regional leader in cardiac, cancer, neuroscience and
orthopedic care, as well as care of women and children, and is a pioneer in
advanced patient safety technology. For more information about the
not-for-profit Sutter Health network, visit the website at
The benefit information provided herein is a brief summary, not a
comprehensive description of benefits. For more information contact the plan.
The AARP(R) MedicareComplete(R) plans are insured through UnitedHealthcare
Insurance Company and its affiliated companies, a Medicare Advantage
organization with a Medicare contract. UnitedHealthcare Insurance Company pays
royalty fees to AARP for the use of its intellectual property. These fees are
used for the general purposes of AARP. AARP and its affiliates are not insurers.
You do not need to be an AARP member to enroll.
AARP encourages you to consider your needs when selecting products and does
not make specific product recommendations for individuals.
Limitations, copayments and restrictions may apply. Benefits may vary by
county and plan.
UnitedHealthcare Sarah Bearce, 952-931-4732 Sarah_Bearce@uhc.com or Sutter Health Sacramento Sierra Region Nancy Turner, 916-454-6569 firstname.lastname@example.org
Copyright Business Wire 2011
SACRAMENTO, Calif.— The state has sanctioned an insurance agent who sold Medicare Advantage plans to seniors even though he didn’t have an insurance license and had a criminal record, officials said Wednesday.
Hussein Osman Ali of Fresno will no longer be able to sell the health plans after an investigation determined his insurance license was already revoked. He had recently pleaded guilty to a federal indictment alleging conspiracy to commit bank fraud, said Brent Barnhart, director of the California Department of Managed Health Care.
Ali was president of Brawley Insurance Services in Fresno.
The agency does not have the power to press criminal charges, Barnhart said.
Barnhart said the case should remind seniors of the hazards of unscrupulous insurance agents when deciding to sign up for Medicare Advantage plans. The plans are privately run versions of the Medicare program that offer basic Medicare coverage topped with extras, like vision or dental coverage, or lower premiums than traditional Medicare.
The two largest Medicare Advantage plan providers based on enrollment are UnitedHealth Group Inc. and Humana Inc.
The option has soared in popularity in recent years. As of September 2010, 11.8 million Medicare beneficiaries, or nearly one-quarter of the total Medicare population, were enrolled in a Medicare Advantage plan, according to a study by the Henry J. Kaiser Family Foundation.
The annual open enrollment for the plans begins Saturday in California, Barnhart said.
The agency has sanctioned 20 insurance agents in the past two years in an attempt to stifle unscrupulous practices, he said.
Copyright 2011 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Medicare Advantage Sales Scams on the Rise in CA
As Medicare Advantage open enrollment season begins Saturday, state managed care officials in California on Wednesday issued a stern public warning about an increase in unscrupulous and illegal sales tactics some agents are using to pitch plans.
“Deceptive marketing of Medicare Advantage products to senior citizens and others eligible for Medicare or Medi-Cal (Medicaid in California) is a relatively new phenomenon in California and in the nation,” Brent A. Barnhart, director of state Department of Managed Health Care said during a news conference.
“These plans can be very beneficial for consumers, but unfortunately, they have also given opportunity for those who would take advantage of the elderly, or vulnerable consumers, by misrepresenting benefits, terms, conditions and co-payments.”
Barnhart invited one victim, Brenda Hoot of Manteca, to the briefing to tell her story.
Hoot was contacted last year by someone who convinced her to switch from her existing plan to a similar one that had lower premium, no deductible, and co-pays merely $10 to $15. She repeatedly called the agent to check whether she had understand the policy correctly. Yes, she was reassured repeatedly. It really was that good.
But after her husband was hospitalized to receive a stent, they started to get the bills and provider demands for $500 per service. Now credit agencies are asking her to pay up nearly $15,000 in medical bills and doctors they see want them to pay up front.
RePublished on October 7, 2011 at 2:20 PM·
Humana Inc. (NYSE: HUM) announced today that it has signed an agreement to acquire MD Care, a California-based Medicare Advantage HMO with approximately 15,000 members in Southern California. Terms were not disclosed.
“As Humana continues growing its Medicare business in the western U.S., MD Care offers an opportunity to expand our Medicare footprint and the suite of products and services we offer in California”
MD Care was founded in 2007 and offers Medicare beneficiaries a choice of plans with comprehensive and value-added alternatives to traditional Fee-for-Service Medicare, including Medicare Advantage medical plans; Medicare Advantage – prescription drug plans (include medical and drug coverage); and Medicare Advantage special needs plans. MD Care’s members reside in four Southern California counties: Los Angeles County, Orange County, San Bernardino County and Riverside County.
“As Humana continues growing its Medicare business in the western U.S., MD Care offers an opportunity to expand our Medicare footprint and the suite of products and services we offer in California,” said Thomas J. Liston, senior vice president of senior products for Humana. “As one of the nation’s leading Medicare companies, with more than 4.3 million Medicare members nationwide and more than 200,000 Medicare members in California, Humana is committed to continued growth in California.”
MD Care’s 2010 revenue was $155 million. The transaction is subject to both federal and state regulatory approvals and is expected to close in late 2011. Humana’s acquisition of MD Care is not expected to materially impact its financial earnings guidance for the year ending December 31, 2011.
Source MD Care
The current Anthem Blue Cross Freedom Blue Plan will be discontinued for the 2012 year. It will be replaced with a County specific Preferred Standard LPPO (Local PPO), which will only be in the following Counties:
Alameda, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Mateo, Santa Clara, Sonoma, Stanislaus and Ventura.
- The new 2012 Anthem Preferred Standard PPO information will be available on October 1st.
- If you are in a County which will not have the new Preferred Standard PPO, please call us and we’ll can check what companies and plans are in your area.
- 800-260-9051 opt2
Anthem Blue Cross Preferred Standard PPO is a Medicare Health plan which offers superb medical coverage along with Prescription drug benefits, so you don’t have to purchase a separate prescription drug plan. Your Anthem Blue Cross Preferred Standard PPO coverage includes access to all of the same prescription options you would have under a stand-alone Medicare Part D drug plan, but you have the convenience of having one ID card you can use for both medical and drug plan coverage.
SCAN Health Plan Announces Medicare Advantage Benefits for 2012
- Press Release Source: SCAN Health Plan On Thursday October 6, 2011, 11:00 am EDT
LONG BEACH, Calif.–(BUSINESS WIRE)– SCAN Health Plan announced today its 2012 benefit package, designed to provide Medicare-eligible Californians easy access to providers and programs designed to keep them healthy and independent. With 130,000 members, SCAN is the third largest Medicare Advantage Prescription Drug (MAPD) plan in California and the fourth largest not-for-profit MAPD in the nation.
In 2012 SCAN will once again offer its competitive MAPD benefits in 11 California counties. In Southern California these include: Los Angeles, Orange, Riverside, San Bernardino, San Diego, Ventura and Kern counties. In Northern California SCAN is offered in Contra Costa, San Francisco, Santa Clara and San Joaquin counties.
Unlike most Medicare Advantage plans, SCAN has no commercial members, which allows it to dedicate 100 percent of its energy and programs toward serving older adults across the wide spectrum of aging. Its focus is to provide affordable and accessible quality healthcare to seniors and to continue to look for innovative ways to serve Medicare members’ healthcare needs.
“We continue to be dedicated to offering seniors and others on Medicare the best possible value when it comes to benefits and services,” said Chris Wing, CEO of SCAN Health Plan. “In keeping with our not-for-profit mission, we’ve worked hard to develop outstanding benefit packages that address seniors’ concerns, wants and needs when it comes to their healthcare.”
The deadline to enroll in a Medicare Advantage plan for 2012 comes nearly a month earlier than it has in years past, running this year from Oct. 15 to Dec. 7. During this time seniors and others on Medicare may choose to switch their health plan or move from traditional Medicare to a Medicare Advantage plan (or move back to Medicare) with their new selections taking effect January 1, 2012.
As governed by the Centers for Medicare and Medicaid Services, member benefits vary by county. Specific information on SCAN’s 2012 benefit offerings is available at www.scanhealthplan.com or by calling 800-915-7226, 8 a.m. to 8 p.m., seven days a week. TTY/TDD users may call 1-800-735-2929.
The fourth largest nonprofit Medicare Advantage health plan in the U.S. is partnering with the American Cancer Society to provide its more than 130,000 members in California with cancer prevention and early detection messages.
Long Beach, Calif.-based SCAN Health Plan is working with the California division of the ACS, in part focusing on how seniors and others on Medicare can manage cancer as a “chronic condition” with new medical advances and constantly emerging information on the disease.
“One of the most effective ways we can enhance and manage our members’ health is through thoughtful and caring partnerships with organizations that have proven to make a difference,” said Timothy Schwab, chief medical officer of SCAN, in a statement. “By working with the American Cancer Society, we can better support our members with facts and information on prevention, detection and disease management.”
Approximately 1.5 million Americans are diagnosed with cancer every year, making cancer the second leading cause of death in the U.S., exceeded only by heart disease.
SCAN Health Plan has nearly 130,000 members in California and Arizona.
Alliance Praises the President’s Economic Proposal
On Monday, President Obama outlined a series of spending cuts and tax increases that will result in $4.4 trillion in deficit reduction. The plan calls for comprehensive tax reform, the closing of tax loopholes, and ending special interest tax breaks. Obama also directs Congress to follow the “Buffett Rule” – named for billionaire Warren Buffett – which says that people making more than $1 million a year should not pay a smaller share of their income in taxes than middle-class families. “The President’s stand on increased revenues will address the nation’s debt in a fair and reasonable manner. Unlike congressional Republicans and presidential candidates, President Obama recognizes the importance of Social Security and will not try to lower federal spending on the backs of current and future retirees. Seniors applaud the President for maintaining the current eligibility age for Medicare and Social Security,” said Edward F. Coyle, Executive Director of the Alliance.
The plan calls for $320 billion in health care savings, most of which would come from reducing payments to Medicare providers and pharmaceutical companies. The President didn’t propose to change the eligibility age for Medicare or make any benefit changes, but did note the prospect of the Super Committee coming up with recommendations for reforming the program. Obama said no savings that affect beneficiaries can begin until at least 2017 and that he would veto any legislation that takes funds from Medicare benefits for seniors without asking the wealthiest Americans and biggest corporations to pay their fair share. “We will work closely with Administration and congressional officials to ensure that seniors do not face unfair cuts in Medicare and Medicaid, which help millions of elderly and low-income Americans stay healthy,” said Mr. Coyle. To see Coyle’s full statement, go to http://bit.ly/oZ3hCQ.
Medicare Advantage Premiums Drop; Medicare Open Enrollment Begins October 15
Last week, the Obama administration announced that Medicare Advantage premiums would decrease by 4% in 2012 as enrollment increased by 1%. Reduced premiums and increased enrollment are the exact opposite of what insurers and Republicans predicted would happen to Medicare Advantage after the passage of the Affordable Care Act. The health reform law reduced payments to Medicare Advantage plans — privately-run alternatives to traditional, fee-for-service Medicare — by about $136 billion over the next decade. Right before the law passed, American’s Health Insurance Plans predicted that “millions of seniors in Medicare Advantage will lose their coverage, and millions more will face higher premiums and reduced benefits.” The Washington Post listed three factors that are putting downward pressure on Medicare: First, Medicare costs are growing more slowly. Both in Medicare and in private insurance, the recession has correlated with patients using fewer medical services. This looks to be particularly true in Medicare, where seniors could have more limited resources living on a fixed income. Second, the Medicare risk pool is becoming younger, and collectively healthier, making them a cheaper group to insure. Medicare doesn’t “age-rate” — charge its older subscribers more. Finally, prescription drug prices are going to become less expensive as some big-name drugs come off patent in the next few months. “The free preventive care for seniors brought by the Affordable Care Act will also result in enormous future savings,” said Ruben Burks, Secretary-Treasurer of the Alliance.
Under a provision of the Affordable Care Act, the Medicare annual open enrollment period changes to Oct. 15 through Dec. 7, 2011. Last year, it was held Nov. 15 through Dec. 31. All Medicare beneficiaries are allowed this one time each year to make changes to their Medicare coverage for the coming year. This includes anyone using traditional Medicare, Medicare Advantage, prescription drug and Medigap supplemental coverage.
Alliance down South: Florida takes on Rick Perry, North Carolina Stays on Message
Republican presidential candidates met in Orlando on Thursday for another big debate. Wednesday night, more than 150 people lined Okeechobee Boulevard in West Palm Beach for a peaceful protest outside Texas Gov. Rick Perry’s fundraiser. “The message we’re sending to Gov. Perry is: you better soon figure out how to retract the statement on Social Security being a Ponzi scheme,” protestor and Florida Alliance President Tony Fransetta said. “It isn’t.” For a photo, go to http://bit.ly/nicdXX.
Heather McLaughlin, Field Organizer for the North Carolina Alliance, educated seniors about Social Security at the Whitaker Glen Retirement Community in Raleigh on Tuesday. Ms. McLaughlin joined representatives from the Triangle Older Women’s League and the Raleigh Chapter of the National Organization for Women.
Alliance Activities out West: California and Spokane, Washington
Shocked to discover there are no restrictions in place to stop retailers from selling expired medications, the California Alliance and other advocacy groups this week joined state lawmakers in support of legislation to ban the sale of outdated medications, as well as baby formula. Consuming expired medication can have serious side effects that could be potentially fatal. “It is both highly irresponsible and quite dangerous to sell expired medication,” said Nan Brasmer, President of the California Alliance. For more information, please visit http://bit.ly/nKFcVH.
Sarah Byrne, Senior Legislative Representative for the Alliance, spoke to approximately 80 Washington State Alliance members – including some representing event co-sponsor United Steelworkers Local 338 – in Spokane on Tuesday. At an intergenerational event that tied in Social Security’s importance to the youth within our communities, Ms. Byrne spoke of the history of Social Security and gave an overview of current legislative activity surrounding the program.
Other Alliance Activities Take Place in West Virginia, Iowa
Barbara J. Easterling, President of the Alliance, addressed the West Virginia Federation of Democratic Women in Huntington, WV on Saturday. “In West Virginia, the average elderly woman’s Social Security check is $954 per month. Does anyone really think that’s why we have a budget deficit?” she asked the crowd.
On Tuesday, the Iowa Alliance launched the Iowa Elder Economic Security Initiative for senior advocacy. A collaboration with the group “Wider Opportunities for Women,” it was made possible by a grant that the Iowa Alliance received last September. The launch took place in Des Moines with over 50 participants, including representatives from the Iowa Farmers Union and others.
By Jon Kamp
Of DOW JONES NEWSWIRES
Humana Inc. (HUM) has reached an agreement to buy a Medicare Advantage
health-management organization called MD Care, furthering the managed-care
company’s goal of boosting its Medicare-based offerings.
Louisville, Ky.-based Humana said the deal, signed for an undisclosed sum,
adds about 15,000 members in Southern California. About a month ago, Humana
agreed to acquire another Medicare Advantage HMO called Arcadian Management
Services that has about 64,000 members in 15 states including California.
“As Humana continues growing its Medicare business in the western U.S., MD
Care offers an opportunity to expand our Medicare footprint and the suite of
products and services we offer in California,” said Thomas J. Liston, senior
vice president of senior products for Humana, in a release Friday.
Medicare Advantage plans are offered by private firms that contract with the
government-based health plan for the elderly. Humana has more than 4.3 million
Medicare members in the U.S., but only about 5% of that total is in the most
populous state. The company is “committed to continued growth in California,”
The new deal “highlights that Humana appears to be increasingly focused on
building out its [Medicare Advantage] franchise in the West,” Deutsche Bank
analyst Scott Fidel said. Humana’s Medicare positions have traditionally been
strong in the South and Midwest, Fidel noted, while other insurers including
WellPoint Inc. (WLP) have had significant businesses in western regions.
“Humana now appears to be ramping up its footprint in the West by rolling up
some of the local operators like Arcadian and MD Care,” Fidel said.
MD Care, founded in 2007, posted revenue of $155 million last year. Humana,
which had 2010 sales of $33.87 billion, said the deal is not expected to
materially impact its earnings guidance for this year. The deal is expected to
close late in the year pending regulatory approval.
Humana on Aug. 1 reported better-than-expected earnings for the second
quarter, helped by its growing membership and an ongoing trend of light
health-care spending. The company raised its full-year earnings forecast at the
time while saying it was also planning to boost spending to market Medicare
The company’s shares recently traded down 46 cents, or 0.6%, to $75.81.
Shares are up about 38% on the year.
-By Jon Kamp, Dow Jones Newswires; 617-654-6728; email@example.com