Beware of Medicare fraud and more during the holidays

Some have dropped classic Medicare in favor of the privately insured version, only to find their medical needs aren’t covered.

By Keelin Everly-Lang • December 3, 2023 7:30 am
Photo by Keelin Everly-Lang Recent mailers in Federal Way that provide reminders to enroll in Medicare Advantage plans. They remind residents that an important enrollment period is happening, but also serve as advertisements for private insurance companies that can be misleading.
Photo by Keelin Everly-Lang Recent mailers in Federal Way that provide reminders to enroll in Medicare Advantage plans. They remind residents that an important enrollment period is happening, but also serve as advertisements for private insurance companies that can be misleading.

Federal Way residents over age 65 may have seen an abundance of flyers on their doorstep this month with urgent notices about Medicare Advantage plans. Many advertise a variety of free perks like groceries or gym memberships, but all might not be as it seems.

Medicare enrollment for 2023 is open until Dec. 7. While enrolling, it is important to know the difference between the Medicare plan offered by the government and the dozens of Medicare Advantage plans offered by private insurance. Medicare scams are also especially prevalent this time of year from entities attempting to acquire personal information for monetary gain.

Frank Fields of the Federal Way Senior Commission told The Mirror that he’s been hearing an increase of seniors in his community who are having trouble navigating these complicated options. Some have dropped classic Medicare in favor of the privately insured version, only to find their medical needs aren’t covered.

To make sure any new or existing plans will fit one’s needs, there are several ways to access reliable information. A Statewide Health Insurance Benefits Advisor (SHIBA) can provide clear and helpful information on plan options and the differences between them. They can be reached by calling 800-562-6900, TDD: 360-586-0241, contacted via a local office, through an online form or even through the mail at SHIBA Office of the Insurance Commissioner, PO Box 40255, Olympia, WA 98504-0255

On the website www.medicare.gov, selecting the “Health and Drug Plans” menu, then navigating to “Find Health and Drug Plans” will allow users to find personalized options. This site will allow a user to evaluate whether they’d like to utilize the classic Medicare plan or even compare the variety of private Medicare Advantage plans, including the option to see how much medications will cost.

In Federal Way, in the zip code 98003 for example, there are 49 Medicare Advantage plans available.

Medicare Advantage plans can provide a variety of positive benefits and coverage that traditional Medicare does not, but can sometimes result in lower levels of care due to denials of coverage. In a Senate subcommittee meeting in May 2023, this issue was discussed at length.

Sen. Richard Blumenthal (D-Conn.) introduced the issue by sharing that over 30 million Americans use Medicare Advantage plans as of 2023, which represents over half of Medicare eligible individuals.

“Many seniors are very happy with Medicare Advantage and want to continue with them,” he stated. “But the reason we are here today is that all too often the big insurance companies that run Medicare Advantage plans have been failing seniors when they need treatment and care. Medicare Advantage insurers are required to provide beneficiaries with the same minimum level of coverage as traditional Medicare. Yet we have seen evidence indicating that in many instances, they are failing to do so.”

Blumenthal added: “Tragically we have heard from many families who faced denials in the middle of major medical crises, forcing them and their loved ones to fight even as they are fighting for their lives.”

One key difference in these situations is that “there is growing evidence that insurance companies are relying on algorithms, rather than doctors or other clinicians, to make decisions to deny patient care,” according to Sen. Blumenthal.

These issues within the insurance system are not limited to Medicare Advantage, but do highlight the importance of weighing options carefully based on reliable sources of information when it comes to health coverage.

Scams

Complicated options for insurance plans are one thing, but there is also an increase in fraud attempts this time of year. Washington state provides some tips to make sure that you don’t get scammed:

• Protect your Medicare number located on your red, white and blue Medicare card. Treat it like a credit card and don’t carry it with you unless you need to use it.

• Do not give out your Social Security, Medicare, and bank account numbers over the phone or in person, unless you made the contact and you trust the person.

• Remember that nothing is ever “free.” Don’t accept offers of money or gifts for free medical care.

• Ask questions. You have a right to know everything about your medical care including the costs billed to Medicare.

• Use a calendar to record all your medical appointments and any tests or x-rays you get. Check it against your Medicare statements to make sure your statements are accurate.

• Be wary of medical providers who tell you the item or service isn’t usually covered, but they “know how to bill Medicare” so Medicare will pay.

• Be cautious if a company requests you pay for premiums in cash, pay a year’s premium in advance, or pressures you to buy right away because “it’s your last chance.”

• Check with the Office of Insurance Commissioner to make sure an insurance company or agent is allowed to do business in Washington state.