The WSJ Health Blog alerts us to the existence of predatory sales scams involving private fee for service (PFFS) Medicare plans.
PFFS is neither traditional Medicare, nor is it the same as private managed care, because it doesn’t have an official network of providers.
They are popular among seniors who want the freedom to choose their doctors and avoid the restrictions of managed-care plans. The government pays PFFS insurers on average 19% above the traditional Medicare costs, which allows them to offer richer benefits with lower costs to patients. But, partly because the plans are new and unfamiliar to many providers, some doctors don’t accept PFFS plans.
Earlier this year, several companies agreed to stop marketing the plans because they weren’t being properly explained to beneficiaries. Patients who enroll in these plans are often shocked to find out that their doctor wouldn’t accept their new insurance.
Here’s how to avoid the scams, from the WSJ:
1. Insist on seeing a written list of doctors, hospitals and prescription drugs that each plan covers and be sure the plan covers any needed special care, such as dialysis.
2. Call your doctors to confirm that they work with the plan you’re considering
3. Insist that the agent show how the plan you’re considering compares with other plans for costs and coverage.
4. Confirm that the agent is licensed by the state.
5. Don’t provide any personal data, such as a Social Security number, until a purchase is certain.
6. Collect a business card from the agent so that you have his or her full name and contact information.
7. Consider having a family member or friend present when meeting with an insurance agent.