Seven companies that market private fee-for-service plans for Medicare have received permission from the Centers for Medicare & Medicaid Services to resume marketing the plans to beneficiaries.
In mid-June, CMS halted marketing by the seven plans, which already were providing coverage for about 90 percent of the 1.3 million beneficiaries enrolled in the private fee-for-service plans, known as Medicare Advantage plans. CMS required the plans to train employees to halt instances of what it called "deceptive marketing practices."
CMS announced that the seven health plan sponsors were found compliant with Medicare requirements after a comprehensive review of their marketing collateral and practices.
Four plans - United Health Group, Blue Cross Blue Shield of Tennessee, Humana Inc. and Sterling Life Insurance Co. - were the latest to meet requirements and receive approval in late September to market their PFFS plans, CMS said. Three other plan sponsors - Coventry Health Care Inc., Universal American Financial Corp. and WellCare Health Plans Inc. - were cleared by CMS in August.
PFFS marketing for calendar year 2008 is already under way, having started on Oct. 1, CMS reported.
The approvals come with a list of requirements for marketing the programs to beneficiaries, CMS noted. For example, plans must call beneficiaries who want to enroll in PFFS plans to confirm they undertstand the terms and conditions. Plans must have outreach and education programs in place for providers. Literature must have specific disclaimer language that fully describes PFFS plans, and CMS plans ongoing monitoring of marketing and sales events.
Critics have charged the plans have used dishonest tactics to sign up beneficiaries and people with disabilities for the programs. The plans are like traditional Medicare in that those covered by fee-for-service plans can choose their own physicians and hospitals; they pay monthly premiums of about $100 a month and copayments of $5 to $20 per physician office visit, compared with a 20 percent copay for traditional Medicare.
In announcing the marketing moratorium in June, CMS said it logged about 2,700 complaints about the Medicare Advantage plans from December 2006 through April. At the time, Abby Block, director of CMS' Center for Beneficiary Choices, attributed the deceptive marketing to "rogue agents" who have contracts with the payers operating the plans.
"Overseeing the marketing activities of Medicare Advantage plans to ensure beneficiaries have access to the healthcare services they need, and are not discriminated against in any way, is one of my top priorities," said CMS Acting Administrator Kerry Weems.
"CMS conducted a comprehensive review of these seven sponsors and found vast improvements in their internal controls and oversight processes. Medicare's procedures to continuously monitor all plan marketing, including the activities of their agents and brokers, are now in place."