With the yearly open enrollment for Medicare kicking off Tuesday, U.S. Sen. Ron Wyden said he is working on fixes to better protect seniors.
Speaking at the Community for Positive Aging in northeast Portland — formerly known as the Hollywood Senior Center — Wyden outlined efforts to reform the federal health insurance program that covers about 923,000 senior Oregonians.
Much of his work has been aimed at privatized Medicare Advantage plans, which in recent years have drawn complaints of red tape that blocks seniors from getting needed care, as well as deceitful advertising that steps up during enrollment season.
“October can be frightening,” Wyden said of open enrollment, which runs through Dec. 7.
Wyden has used his post as chair of the Senate Finance Committee to press for a crackdown on aggressive marketing by Medicare Advantage plans. Regulators responded by blocking middlemen from selling seniors’ personal information or sending them documents that deceptively resemble tax forms.
Currently, he said he is working on addressing the use of prior authorization in Medicare Advantage. Insurers use the process to review the medical necessity of treatments as a cost-control measure. However, Wyden said that in 2022 Medicare Advantage plans denied 46 million coverage requests.
Wyden said he is hearing from seniors and providers that these plans are using a “deny-first system” that he said “guarantees unnecessary delays to accessing care and big paperwork burdens for you and for the providers.”
Additionally, Wyden said he is working on addressing “ghost networks,” insurer directories padded withs inaccurate phone numbers or contacts for unavailable providers, which he called “one of the biggest rip-offs ever.”
Lastly, Wyden said he has asked federal regulators to ban Medicare Advantage insurers from paying brokers more money for enrolling seniors in certain plans. He said that the practice can result in seniors being enrolled in plans that have extra expenses but few benefits.
Wyden noted that help is available for navigating enrollment in Medicare plans and pushing back on potential abuses. That help is Oregon’s Senior Health Insurance Benefits Assistance Program, or SHIBA.
Carisa Dickson, head of the program for Multnomah County, told the crowd that she said that the program’s 23 trained volunteers can help seniors understand their options or overcome problems. Seniors can schedule an appointment by calling 503-988-3646 and selecting option 3. The Multnomah program is holding a series of events at libraries and community centers during open enrollment, and other local SHIBA offices often offer their own resources and specialized help (local office locator found here).
“Some salespeople may pressure you to join a Medicare plan that does not suit your needs,” Dickson said, adding that “They might claim that your doctors are in-network and that your medications are on the formulary … However, you may find later on that this is not the case. This can be a very serious problem.”
After the event, Dickson told The Lund Report that Medicare Advantage plans are changing cost structures or cutting back services, such as vision, dental and alternative medicine. She encouraged seniors to closely compare policies.
“People who had a great deal this year are not having that deal next year,” she said.
If we all pay the same money towards Medicare, why are the plans' benefits dependent upon where you live when you get Medicare? I worked in California in a big city all my life, moved to Oregon in retirement and my local plans are terrible and poorly rated as well..