The debate continues over Medicare Advantage and whether or not private Medicare plans are a good thing for seniors and/or Medicare.  Plan information is now available on the Medicare.gov website where you can compare the details of plans offered in your state and county.

Seniors in Arizona are facing substantial changes in their plans in 2010, including a $36 monthly premium for a plan that has always been $0.  Doctor visit co-pays have gone up about $5 in every plan offered in Pima County. Hospital co-pays that would be $900 in 2009 will be $2,000 next year.  Seniors are advised to get sick before the end of this year to save money.  (Just kidding.) 

I decided to take a look at plans in Florida, where Medicare pays insurance companies the highest amount for seniors enrolled in Medicare Advantage plans, and I was shocked to see that seniors in Florida are not facing the same cost increases as older citizens in Arizona. In fact, for seniors enrolled in most HMO Medicare Advantage plans in Florida, their healthcare is practically free!

 Let’s look at plans offered by the same company, Humana, in both Arizona and Florida.  I was shocked by the differences.

 Our own Senator Kyl  has been a vocal defender of Medicare Advantage plans, saying seniors in our state should not lose the benefits and choice offered through private Medicare plans.  Senator Ben Nelson, a Democrat from Florida, added an amendment to the Senate Finance Committee healthcare bill that would protect added benefits in Medicare Advantage plans such as free gym memberships, dental and vision services.

Senator Kyl seems to be protecting choices for Arizona seniors that are mediocre at best, while Senator Nelson’s constituents have the gold standard in healthcare plans.

I have a question for Senator Kyl:  Why are seniors in Florida getting practically-free healthcare while seniors in Arizona face rising costs and reduced benefits under Medicare Advantage plans?

An article on today’s front page of the Washington Post talks about how Tucson is in the middle of the debate over Medicare Advantage plans, which Obama wants to cut.

Here is the link: 

http://www.washingtonpost.com/wp-dyn/content/article/2009/10/14/AR2009101403953.html?hpid=topnews

Insurance agents have turned up at the homes of seniors stating they are from Medicare and that they need to talk about the senior’s Medicare coverage.   Health fairs have invited seniors in for flu shots and free food, with hopes of getting leads for insurance agents who can follow up with sales calls.

These are just a few examples of problems that have plagued the Medicare market over the years.  Now rules are in place and secret shoppers are lurking to make sure insurance agents comply with the many new rules concerning sales and marketing of Medicare Advantage plans.

Here are a few of the rules related to Medicare Advantage sales and Marketing:

• While knocking on seniors’ homes without an invitation has always been against the rules, now agents are forbidden from initiating contact with Medicare beneficiaries in any way, except by mail.  Agents can call their own clients, but they cannot call someone they have never worked with.
• Agents can ask clients for referrals of friends and relatives, but they cannot receive phone numbers to call these prospects.  If a senior wants to help a friend, she needs to give her friend the agent’s phone number so the friend can initiate contact with the agent.
• When an appointment is made between an agent and a senior to talk about Medicare Advantage, both parties must clearly agree on what will be discussed.  A form called a “scope of appointment” must be signed by the senior before Medicare Advantage plans are discussed. This form should be mailed to the senior and the senior must mail the form back to the agent after signing it and agreeing to the scope of the appointment.
• Agents have the option of recording the phone call during which the terms of the appointment are reviewed and agreed upon.
• If a neighbor shows up for the arranged appointment, she must sign a scope of appointment before the discussion of Medicare Advantage can begin.
• Educational events, such as health fairs, can include insurance agents, but agents cannot present any plan-specific Medicare Advantage information to attendees. Agents cannot give their card to attendees – unless an attendee asks the agent for his/her card.
• Educational events are defined as any event that provides free food.
• Sales events must be registered in advance with Medicare so secret shoppers can attend to be sure agents are compliant in their sales presentations about Medicare Advantage.

I’m not going to editorialize about these rules for fear of breaking any rules.