FOR IMMEDIATE RELEASE
Contact: Akiko Takano
Deputy Director of Communications
June 15, 2010
Consumer Group Releases Report on Why People Disenroll from
Medicare Private Health Plans
-- Report Highlights Problems Consumers Face; Calls for
National Disenrollment Survey --
New York, NY—The Medicare Rights Center today released a report on consumers’ reasons for disenrolling from Medicare private health plans in the Medicare Advantage (MA) program. The report, Medicare Facts and Faces: Why Consumers Disenroll from Medicare Private Health Plans, examines data from calls placed in 2009 to the Medicare Rights Center’s national hotlines for people with Medicare.
The report explores the issues that prompt consumers to disenroll, and identifies the most common reasons for disenrollment: problems accessing providers, misinformation and marketing abuse, and coverage denials for medical services.
The report makes two primary reform recommendations:
- Given the high incidence of problems with marketing abuse and provider access found in the Medicare Rights Center’s hotline data, the report calls on the Centers for Medicare & Medicaid Services (CMS) to strengthen oversight of plans’ marketing practices, and underscores the need to educate consumers about network and coverage restrictions.
- The report also calls on CMS to resume collecting and publishing a national disenrollment survey that would contain plan-specific data on consumers’ reasons for disenrolling.
“Consumers not only need and deserve access to private health plans’ disenrollment rates, but they also need to know the reasons why people disenrolled from a particular plan in the past, so that they can properly evaluate a plan before making an enrollment decision.” said Medicare Rights Center President Joe Baker. “This plan-specific information and aggregate data about reasons for disenrollment can also alert policymakers and regulators to misconduct and positive or negative trends in the MA program. It is imperative that CMS provide a national disenrollment survey with plan-specific information about reasons for disenrollment to empower consumers and improve the MA program.”
The report also found that a large number of consumers are prompted to disenroll by more than one problem. For Mr. R, a 78-year-old man from South Carolina, the trouble started with marketing abuse, when his insurance agent paid him a visit and advised him to “update” his health insurance. Although he was happy with his current Medicare HMO, he switched based on the promises of better coverage made by the insurance agent. Those promises proved to be false, and Mr. R ran up $700 in copay bills because his doctors were not in-network. Only after the Medicare Rights Center intervened was Mr. R able to retroactively enroll in his old Medicare HMO.
Medicare private health plans, which are commonly known as “Medicare Advantage” plans, contract with Medicare to provide Medicare benefits to consumers. They include plans such as: Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO) and Private Fee-For-Service (PFFS) plans. Approximately 11.1 million people, one quarter of people with Medicare, are enrolled in a private health plan in 2010.*
“Older adults and people with disabilities should think carefully and read the fine print before joining a Medicare private health plan,” said Baker. “It is critical for consumers to confirm that the plan will cover the care they need from their doctors at a price they can afford.”
People with Medicare who are currently enrolled in a private plan can generally change plans only during the Annual Coordinated Election Period, which this year begins on November 15 and ends on December 31. Some people are given a Special Enrollment Period to switch plans outside of standard enrollment periods, including people who move out of their plan area or experience marketing fraud and abuse.
Medicare Facts and Faces: Why Consumers Disenroll from Medicare Private Health Plans is the first in a new series of reports to be released by the Medicare Rights Center.
The report is available at www.medicarerights.org/pdf/Why-Consumers-Disenroll-from-MA.pdf.
*The Henry J. Kaiser Family Foundation, Explaining Health Reform: Key Changes in the Medicare Advantage Program, May 2010. http://kff.org/healthreform/upload/8071.pdf
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Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs, and public policy initiatives.
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