Medicare phone scammers want to slash your benefits and leave you with fewer in-network providers

You answer the phone and you’re greeted by a weird tone, followed by a few seconds of silence.

Then comes a voice saying “I’m with Health Care Benefits” or “Medicare Services” or something else equally as generic.

The voice promises to improve your Medicare benefits, possibly save you money, or even get you more money in your Social Security check. “Hold on to be transferred to one of our agents,” the caller says.

Your phone displays a local number, “spoofed” to make you think it’s someone you know. Perhaps your phone displays the words “Potential Spam.” Then there are odd beep, clicks and call center chatter in the background.

Is it a spam call intending to trick you into giving your birthdate, Social Security number, bank account number, so some oversees crooks can steal your money?

Possibly, or it could be a scam cloaked in legitimacy.

Chances are good the registered agent who comes on the line next works for an actual health insurance agency that can switch you into a Medicare Advantage plan that’s very different than the one you have now. Those plans have multiple variations and the agent might not disclose an inferior plan’s limitations and won’t necessarily get your permission to make the switch.

According to Medicare experts and a new study released last week by the Senate Committee on Finance, the inferior plan could leave you without a prescription drug benefit, or omit your favorite doctors from your available in-network providers. And you won’t find out until it’s too late to change back.

The agencies work with lead-generation companies that are bombarding older people in Florida and across the country with unsolicited and possibly illegal solicitation calls, according to independent health insurance agents and telemarketing experts.

The unwanted calls began weeks before this year’s Medicare Advantage enrollment period began on Oct. 15 and they are continuing as the days count down to the Dec. 7 deadline.

100 million unwanted Medicare calls

According to YouMail, a screening service for unwanted calls, at least 100 million Medicare-related robocalls were detected in October from more than 100,000 phone numbers, real and spoofed.

“This is likely to try to get their calls through various spam filters, whether the carriers’ or third-party [filter] apps,” says Alex Quilici, YouMail’s CEO.

“It’s very annoying,” says Mindy Koch, a Boca Raton senior who says she started getting the calls three months before the enrollment period began.

“When they call me, I ask them, ‘What is your company’s name?’ They tell me and I go, ‘Perfect. I’m going to turn that in with your phone number to the Medicare Hot Line.’”

More and more Medicare Advantage consumers are filing complaints to the toll-free Medicare line — 1-800-Medicare — and other agencies, according to a report released Thursday by the Senate Committee on Finance.

The report, based on information compiled by the federal agency that runs the Medicare program, the Centers for Medicare & Medicaid Services (CMS), criticizes shady and misleading business practices by health insurance agencies licensed to sell Medicare Advantage plans.

Those agencies rely on what are known as lead-generation services to identify qualified prospects, the report says. Those services, which use television and print advertising as well as telemarketing and robocall dialers, are often inundating Medicare beneficiaries with “aggressive marketing tactics as well as false and misleading information.”

Medicare is confusing

One reason the agencies are able to deceive consumers is that Medicare, for many, has become complicated to understand. To start with, there are three main kinds of Medicare plans:

“Original” Medicare — This consists of Parts A and B. Part A covers hospitalization and stays in skilled nursing facilities. It’s free for anyone who qualifies for Social Security, even if they haven’t claimed it yet. Part B is the portion that provides standard health insurance, such as doctor visits, outpatient services that do not require hospitalization, lab tests, flu shots and physical therapy. Members pay a monthly premium that’s automatically deducted from their Social Security checks, if they get one. Currently the premium is $170.10 and will go down to $164.90 in 2023.

Part C — This is Medicare Advantage. Unlike Original Medicare, Medicare Advantage plans are run by private health insurers, often but not always the same large insurers that provide employer-sponsored health insurance and individual coverage that we know as Obamacare. Medicare Advantage plans combine Parts A and B with Part D, the prescription drug benefit, Part D, that would otherwise require an additional monthly premium.

Like private insurance, Medicare Advantage plans can offer coverages not provided by Original Medicare, like fitness programs, some vision, hearing and dental services, transportation, and over-the-counter drugs, and can also be tailored to specific chronic conditions. They also may have networks of providers in members’ local areas that they can visit for lower co-pays.

Unlike Original Medicare, Medicare Advantage plans have yearly limits on members’ out-of-pocket cost for Parts A and B services. Once those limits are reached, members pay nothing for the remainder of the year.

Seniors who choose a Medicare Advantage plan still must pay for Medicare Part B. According to the nonprofit Kaiser Family Foundation, 69% of Medicare Advantage enrollees pay no supplemental premiums for the add-on services, while average monthly cost for the remaining 31% is $58 for 2022 plans.

Widespread fraud found

The Senate Finance Committee report found that shady agencies use the complexities of the Medicare system to their advantage when they get a willing prospect on the line.

It summarizes results of an inquiry triggered by marketing complaints in 14 states, including Florida. CMS received 39,617 complaints about false and misleading marketing in 2021 — twice as many as the 15,497 received in 2020, the report says.

The report found numerous examples of “fraudulent and misleading practices”:

In one example cited in the report, an Oregon man agreed to switch to a plan after an agent told him he could get an extra $135 a month in his Social Security check. It wasn’t until he went to his pharmacy to fill his prescription that he learned his new plan did not include Part D, which covers prescription drugs. According to the man’s complaint, the agent failed to disclose that he would lose his drug benefit.

Callers violate rules, ignore laws

It’s hard to escape Medicare-related marketing calls, even for consumers not old enough to qualify for Medicare.

Sherri Kelley, an independent health insurance agent who serves clients throughout Florida from her office in the Tampa Bay area, said she started getting the calls this year. She’s 51.

Kelley, who also sells Medicare Advantage plans, says she has no idea why she ended up on the telemarketers’ call lists. She’s been on the state Do Not Call list for more than a decade.

Federal law prohibits unsolicited telemarketing calls, and Medicare rules prohibit cold calling. It’s possible that she signed or checked some sort of agreement with consent to Medicare calls buried in the fine print, but she doesn’t remember, she says.

YouMail’s Quilici notes that lead-generation companies “appear to be violating consent rules — calling people who never gave them explicit consent to call them or don’t believe they gave consent.” He added, “They also appear to be violating other aspects of the telemarketing sales rules and Telephone Consumer Protection Act, such as not having a clear way to opt out of future calls, and always identifying clearly who they are and what organization they are from, though some do.”

Because she serves so many clients, Kelley says she answers incoming calls that display local numbers on her smart phone. When she realizes she’s getting a Medicare call, she’ll sometimes stay on the line until she is transferred to a live agent. That’s because she knows those agents must pay for every qualified prospect transferred to their phone line by the lead generators.

“In my mind, it’s like, I’m going to make you pay to talk to me,” she says.

Almost always, she adds, the agent fails to read a disclaimer that CMS on Oct. 1 began requiring agents to read within the first 60 seconds of any call. The disclaimer reads, ““We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.”

If agents refuse to follow a requirement within the first 60 seconds of a call, Kelly says, how can one trust anything they say during the rest of the call?

Other deceptions she’s noted include that “they like to say ‘I’m a registered Medicare agent.’ No you’re not. None of us are. We’re licensed with the state to sell health insurance.”

Seniors trust someone who says they’re with Medicare, she says. They’re from a generation that doesn’t want to hang up on people because it’s rude, she said.

Although she finds the calls annoying, at 51 she knows she won’t be signed up for a bad Medicare plan anytime soon, but she feels bad for seniors who get them and have trouble figuring out how to respond.

In an email, a spokesperson for the Centers for Medicare & Medicaid Services said the agency is taking steps to “protect Medicare beneficiaries by ensuring they receive accurate and accessible information about Medicare coverage.” These efforts include changing marketing and communication requirements, and holding health insurers responsible for the activities of agents that work on their behalf.

Kelley, meanwhile, recommends that consumers just don’t answer the calls, or if they do, do not engage with the people on the other end. “I tell them hanging up is not rude, it’s the new normal. Just hang up.”

And don’t respond to anything with the word “yes.” Unscrupulous companies can manipulate recordings of you saying “yes” to make it appear as if you said yes to switching your Medicare Advantage plan, she said.

“Instead, I tell people, ‘Find an independent health insurance agent you can trust,’” she says. “Find someone who will let you ask questions, who will always tell you the truth. Find someone with access to all the plans, not just plans offered by a specific carrier.”

Because it can be difficult to know how to find a trustworthy agent with an internet search, Kelley suggests asking friends for referrals.

That’s how she gets most of her business, she says. “As long as I’m doing right by my clients, I get referrals,” she said.

Ron Hurtibise covers business and consumer issues for the South Florida Sun Sentinel. He can be reached by phone at 954-356-4071, on Twitter @ronhurtibise or by email at rhurtibise@sunsentinel.com.

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