© 2024 Ideastream Public Media

1375 Euclid Avenue, Cleveland, Ohio 44115
(216) 916-6100 | (877) 399-3307

WKSU is a public media service licensed to Kent State University and operated by Ideastream Public Media.
Play Live Radio
Next Up:
0:00 0:00
Available On Air Stations

Medicare director urges Northeast Ohio seniors use federal resources to avoid fraud

Picture of CMS Director Dr. Meena Seshamani
Centers for Medicare and Medicaid Services
CMS Director Dr. Meena Seshamani

The director of the Center for Medicare wants eligible Northeast Ohio seniors to check into possible new coverage options during the insurance program's ongoing open enrollment period because new cost-savings programs are available.

Dr. Meena Seshamani, director of the Center for Medicare, told Ideastream Public Media it is important to review plans each year.

"Options change each year," she said. "Your health needs may change each year, and your financial situation may change. And it's important every year to see whether you are in the option that works best for you and for this open enrollment in particular."

According to Healthy Northeast Ohio, 22.5% of adults in the following counties are on Medicare: Ashland County, Ashtabula County, Cuyahoga County, Geauga County, Lake County, Lorain County, Medina County, Portage County and Summit County. Healthy Northeast Ohio is a health statistics database established by The Center for Health Affairs, a regional hospital advocacy association.

This year it is potentially even more important for beneficiaries to consider their options given a number of changes to the law over the past year, Seshamani said.

"There are a lot of great changes coming with the Medicare program thanks to the new drug law that make it even more important for people to see if they're in the option that works best for them," she said.

That law, the Inflation Reduction Act of 2022, includes provisions such as an expansion of financial assistance programs, a cap on healthcare costs and a monthly $35 cap on out-of-pocket insulin costs.

For example, starting Jan. 1, once an individual's out-of-pocket spending reaches $8,000, they will automatically get “catastrophic coverage" where the individual won’t have to pay a copayment or coinsurance for covered Part D drugs for the rest of the calendar year.

Also, the federal government is expanding its Extra Help affording prescription drug coverage, the Part D low-income subsidy program, starting Jan. 1 to cover more drug costs for people who earn less than 150% of the federal poverty level. According to the Medicare.gov website, people who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.

Seshamani recommended Medicare beneficiaries use official government resources to review their plan options and make changes in order to avoid fraudulent or misleading information. She added Ohio residents are also able to turn to the Ohio Department of Insurance for the information they need.

Medicare’s open enrollment period began Oct. 15 and runs through Dec. 7, providing beneficiaries the opportunity to review and change their prescription drug and health coverage options. Beneficiaries who miss the deadline will likely have to wait a full year before they can make changes to their plan.

Seshamani recommends customers use either the federal government's website, Medicare.gov, or phone number, 1-800-Medicare, to make any changes to their policies in order to avoid fraud.

She added Medicare is aware of seniors receiving such information and was taking action to counter this.

"We also have heard about the misleading marketing practices and we are increasing our oversight," she told Ideastream. "In fact, we just rejected 300 television ads that were found to be misleading."

Medicare has also warned insurance agents and brokers about their sales tactics and what is expected of them, Seshamani said.

"The agents and brokers, they have to disclose that they are only selling certain plans," she said. "And also they're not supposed to use the Medicare logo in a misleading way."

In the meantime, Ohio Senior Health Insurance Information Program Director Chris Reeg testified Oct. 18 before the United States Senate Finance Committee about such deceptive practices.

She called for additional consumer protections to counter these practices.

“In my time with OSHIIP, I have witnessed extreme growth,” she said in her written testimony. “Growth of the Medicare population, growth within the scope of SHIP work, and extreme growth in plan options. Our Medicare consumers are overwhelmed by the volume of options in every county, they are flooded with plan marketing and often confused by the variance in plan benefits, networks, and added benefits. This often leads to poor enrollment decisions and undesirable outcomes.”

Reeg suggested several solutions.

“A personalized Annual Notice of Change would assist beneficiaries in better identifying plan changes, such as higher premiums and copays, from year-to-year,” she said as part of her testimony. “Stronger oversight on utilization of special election periods, such as the low-income subsidy special enrollment period, and a block on enrollments for those with cognitive impairments could minimize improper sales to our most vulnerable beneficiaries. Reinstatement of measurable differences when approving plan contracts would help contain the volume of plans in each county. These actions could make the process of choosing and enrolling in a Medicare plan less intimidating.”

Stephen Langel is a health reporter with Ideastream Public Media's engaged journalism team.