Medicare Advantage Plan Investigated for Abusive Marketing to Elderly Poor

The Massachusetts Division of Insurance is investigating a Medicare Advantage health plan following a growing number of complaints that sales representatives used misleading and abusive marketing practices in recruiting elderly beneficiaries.

The plan, called the Evercare Special Needs Plan for People with Limited Income, is administered by one of the country's biggest health insurers, UnitedHealth Group Inc. Since its introduction in Massachusetts in 2006 to serve disabled elderly individuals eligible for both Medicare and Medicaid, the plan has attracted some 3,000 enrollees.

Massachusetts is investigating dozens of complaints from seniors who claim their Evercare sales representatives either refused to leave their home without a signature or kept calling, despite requests from the family to stop. Other complaints alleged that salespeople misrepresented the plan. Carmen Pola, 69, told the the Boston Globe. that when she signed on with Evercare, she was never told that her co-pays would go up from $15 to $25 for each doctor visit, or that her husband's insulin, formerly $5 each month, would now cost $200. "I panicked. I felt responsible. I found myself begging for a bottle of insulin," Pola said.

The federal Centers for Medicare and Medicaid Services (CMS) is also looking into the company. "This situation convinces us we need to put [Evercare] under a microscope," Jack Cheevers, the CMS spokesman, told the Globe.

Medicare Advantage plans, promoted by the Bush administration in an effort to privatize Medicare, entice seniors to leave the regular Medicare program by offering added benefits, such as dental coverage. The policies have been popular. But as their popularity has increased, so have allegations that the plans are being sold by means of coercion and false information. (See "Some Discover That Medicare Advantage Is to Their Disadvantage.")

Evercare claims that some of the complaints are the result of confusion over the terms of two different policies they have been offering elderly customers. An Evercare spokesman, Jonathan D. Stone, confirms that some brokers have already been terminated. and others are under investigation. Meanwhile, the company is suspending all independent broker sales of its policy in Massachusetts, at least through the end of the year.

According to CMS, Evercare was faulted for dubious sales practices before, in 2006. As a result, the company was instructed to make sure seniors who signed up with them understood exactly what they were buying.

For information on a Medicare Rights Center report, Too Good To Be True: The Fine Print in Medicare Private Health Care Benefits, click here.

For more on the Medicare program, click here.