Uncle Sam wants you ... to help stop health-insurance companies from using misleading tactics to sell Medicare Advantage plans

iStock/Getty Images Plus illustration via KFF Health News

By Susan Jaffe
KFF Health News

After an unprecedented crackdown on misleading advertising claims by insurers selling private Medicare Advantage and drug plans, the Biden administration hopes to unleash a special weapon to make sure companies follow the new rules: you.

Officials at the Centers for Medicare & Medicaid Services are encouraging seniors and other members of the public to become fraud detectives by reporting misleading or deceptive sales tactics to 1-800-MEDICARE, the agency’s 24-hour information hotline. Suspects include postcards designed to look like they’re from the government and TV ads with celebrities promising benefits and low fees that are available only to some people in certain counties.

The new rules, which took effect Sept. 30, close some loopholes in existing requirements by describing what insurers can say in ads and other promotional materials as well as during the enrollment process.

Insurance companies’ advertising campaigns are in high gear because Dec. 7 is the end of open-enrolment season, when seniors can buy policies that take effect Jan. 1. People with traditional government Medicare coverage can add or change a prescription drug plan or join a Medicare Advantage plan that combines drug and medical coverage. Although private Advantage plans offer extra benefits not available under the Medicare program, some services require prior authorization and beneficiaries are confined to a network of health care providers that can change anytime. Beneficiaries in traditional Medicare can see any provider.

Catching Medicare Advantage plans that step out of line isn’t the only reason to keep an eye out for marketing scams. Accurate plan information can help avoid enrollment traps in the first place.

Although insurers and advocates for older adults have generally welcomed the new truth-in-advertising rules, compliance is the big challenge. Expecting beneficiaries to monitor insurance company sales pitches is asking a lot, said Semanthie Brooks, a social worker and advocate for older adults in northeast Ohio. She’s been helping people with Medicare sort through their options for nearly two decades. “I don’t think Medicare beneficiaries should be the police,” she said.

Choosing a Medicare Advantage plan can be daunting. In Ohio, for example, there are 224 Advantage and 21 drug plans to choose from that take effect next year. Eligibility and benefits vary by county.

“CMS ought to be looking at how they can educate people, so that when they hear about benefits on television, they understand that this is a promotional advertisement and not necessarily a benefit that they can use,” Brooks said. “If you don’t realize that these ads may be fraudulent, then you won’t know to report them.”

Meena Seshamani, CMS’s Medicare director, told KFF Health News in a written statement that the agency relies on beneficiaries to help improve services: “The voices of the people we serve make our programs stronger,” she said, noting that complaints from policyholders prompted the government’s action. “That’s why, after hearing from our community, we took new critical steps to protect people with Medicare from confusing and potentially misleading marketing.”

Although about 31 million of the 65 million people with Medicare are enrolled in Advantage plans, even that may not be enough people to monitor the tsunami of advertising on TV, radio, the internet, and paper delivered to actual mailboxes. Last year more than 9,500 ads aired daily during the nine-week marketing period that started two weeks before enrollment opened, according to an analysis by KFF. More than 94% of the TV commercials were sponsored by health insurers, brokers, and marketing companies, compared with only 3% from the federal government touting the original Medicare program.

During just one hourlong Cleveland news program in December, researchers found, viewers were treated to nine Advantage ads.

This year, for the first time, CMS asked insurance and marketing companies this year to submit their Medicare Advantage TV ads to make sure they complied with the new rules. Officials reviewed 1,700 commercials from May 1 through Sept. 30 and nixed more than 300 they deemed misleading, according to news reports. An additional 192 ads out of 250 from marketing companies were also rejected. The agency would not disclose the total number of TV ads reviewed and rejected this year or whether ads from other media were scrutinized.

The new restrictions also apply to salespeople, whether their pitch is in an ad, written material, or a one-on-one conversation. Under one important new rule, the salesperson must explain how the new plan is different from a person’s current health insurance before any changes can be made.

That information could have helped an Indiana woman who lost coverage for her prescription drugs, which cost more than $2,000 a month, said Shawn Swindell, the State Health Insurance Assistance Program supervisor of volunteers for 12 counties in east-central Indiana. A plan representative enrolled the woman in a Medicare Advantage plan without telling her it didn’t include drug coverage, because the plan is geared toward veterans who can get drug coverage through the Department of Veterans Affairs instead of Medicare. The woman is not a veteran, Swindell said.

In New York, the Medicare Rights Center received a complaint from a man who had wanted to sign up just for a prepaid debit card to purchase nonprescription pharmacy items, said the group’s director of education, Emily Whicheloe. He didn’t know the salesperson would enroll him in a new Medicare Advantage plan that offered the card. Whicheloe undid the mistake by asking CMS to allow the man to return to his previous Advantage plan.

Debit cards are among a dizzying array of extra nonmedical perks offered by Medicare Advantage plans, along with transportation to medical appointments, home-delivered meals, and money for utilities, groceries, and even pet supplies. Last year, plans offered an average of 23 extra benefits, according to CMS. But some insurers have told the agency only a small percentage of patients use them, although actual usage is not reportable.

This month, CMS proposed additional Advantage rules for 2025 plans, including one that would require insurers to tell their members about available services they haven’t used yet. Reminders will “ensure the large federal investment of taxpayer dollars in these benefits is actually making its way to beneficiaries and are not primarily used as a marketing ploy,” officials said in a fact sheet.

Medicare Advantage members are usually locked into their plans for the year, with rare exceptions, including if they move out of the service area or the plan goes out of business. But two years ago, CMS added an escape hatch: People can leave a plan they joined based on misleading or inaccurate information, or if they discovered promised benefits didn’t exist or they couldn’t see their providers. This exception also applies when unscrupulous plan representatives withhold information and enroll people in an Advantage policy without their consent.

Another new rule that should prevent enrollments from going awry prohibits plans from touting benefits that are not available where the prospective member lives. Empty promises have become an increasing source of complaints from clients of Louisiana’s Senior Health Insurance Information Program, said its state director, Vicki Dufrene. “They were going to get all these bells and whistles, and when it comes down to it, they don’t get all the bells and whistles, but the salesperson went ahead and enrolled them in the plan.”

So, expect to see more disclaimers in advertisements and mailings like this unsolicited letter an Aetna Medicare Advantage plan sent to a New York City woman: “Plan features and availability may vary by service area,” reads one warning packed into a half-page of fine print. “The formulary and/or pharmacy network may change at any time,” it continues, referring to the list of covered drugs. “You will receive notice when necessary.”

The rules still let insurers to boast about their CMS one-to-five-star ratings, even though the ratings do not reflect the performance of specific plans that may be mentioned in an ad or displayed on the government’s Medicare plan finder website. “There is no way for consumers to know how accurately the star rating reflects the specific plan design, specific provider network, or any other specifics of a particular plan in their county,” said Laura Skopec, a senior researcher at the Urban Institute, who recently co-authored a study on the rating system.

And because ratings data can be more than a year old and plans change annually, ratings published this year don’t apply to 2024 plans that haven’t even begun yet — despite claims to the contrary.

How to spot misleading Medicare Advantage and drug plan sales pitches (and what to do about it)

The Centers for Medicare & Medicaid Services has new rules cracking down on misleading or inaccurate advertising and promotion of Medicare Advantage and drug plans. Watch out for pitches that:

• Suggest benefits are available to all who sign up when only some individuals qualify.
• Mention benefits that are not available in the service area where they are advertised (unless unavoidable because the media outlet covers multiple service areas).
• Use superlatives like “most” or “best” unless claims are backed up by data from the current or prior year.
• Claim unrealistic savings, such as $9,600 in drug savings, which apply only in rare circumstances.
• Market coverage without naming the plan.
• Display the official Medicare name, membership card, or logo without CMS approval.
• Contact you if you’re an Advantage or drug plan member and you told that plan not to notify you about other health insurance products.
• Pretend to be from the government-run Medicare program, which does not make unsolicited sales calls to beneficiaries.

If you think a company is violating the new rules, contact CMS at 1-800-MEDICARE, its 24-hour information hotline. If you believe you chose a plan based on inaccurate information and want to change plans, contact CMS or Kentucky's State Health Insurance Assistance Program at 1-877-293-7447 or online at https://chfs.ky.gov/agencies/dail/Pages/ship.aspx. For more information about protecting yourself from marketing violations, go to www.shiphelp.org/about-medicare/blog/protecting-yourself-marketing-violations.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at the Kaiser Family Foundation, an independent source of health policy research, polling and journalism. Reporter Susan Jaffe is at Jaffe.KHN@gmail.com.

Beshear win pressures legislature to put exceptions for rape and incest, topic of impactful TV ad, into state's near-total abortion ban

Hadley Duvall, a Midway University senior, appeared in a TV commercial for Gov. Andy Beshear.

By Deborah Yetter

Kentucky Lantern

Standing before cheering supporters on election night, Kentucky Gov. Andy Beshear wrapped up his re-election celebration with a round of thanks.

“First to my parents,” he said, embracing Jane and Steve Beshear — his father himself a former, two-term governor.

The Democratic incumbent, who defeated Republican Attorney General Daniel Cameron by 5 percentage points, next thanked his wife, Britainy and their children, Will and Lila.

Then Beshear thanked a young woman in the crowd who appeared in a television ad that became the flashpoint of his campaign — describing her childhood rape and pregnancy and blasting Cameron for his support of Kentucky’s near-total ban on abortion.

“To tell a 12-year-old girl she must have the baby of the stepfather who raped her is unthinkable,” Hadley Duvall sayid in the ad.

“Hadley is here tonight,” Beshear said of the 21-year-old Midway University senior from Owensboro who appeared in what political observers say was a devastatingly effective ad. “Because of her, this commonwealth is going to be a better place and people are going to reach out for the help they need. Thank you, Hadley.”

Abortion remains essentially illegal in Kentucky under a pair of laws enacted by the Republican-controlled General Assembly that provide no exceptions for pregnancies from rape or incest — laws Cameron, as attorney general, has defended.

The laws took effect after the U.S. Supreme Court last year struck down the landmark Roe v. Wade decision of 1973, establishing abortion as a constitutional right.

The Republican supermajority in the state legislature has shown little interested in changing Kentucky’s laws, even to add exemptions for rape or incest. But supporters of abortion rights are hopeful that Beshear’s reelection in a deep red state marks a turning point in attitudes about access to abortion as well as an awakening among voters about the real-life impact of laws that ban it.

“I think it is very obvious that abortion has become an issue that people are not afraid to talk about any longer and that certainly does drive people to the polls,” said Angela Cooper, communications director for the American Civil Liberties Union of Kentucky.

Tamarra Wieder, state director for Planned Parenthood Alliance Advocates Kentucky, noted that the Nov. 7 re-election of Beshear, a supporter of abortion rights, came the same day that voters in Ohio, also a conservative state, approved a ballot measure establishing a state constitutional right to abortion.

And Beshear’s win comes one year after Kentucky voters rejected a ballot measure that would have declared Kentucky’s constitution creates no right to abortion. About 52% of the state’s voters opposed the measure — about the same share of voters who elected Beshear to a second term, Wieder said.

“I don’t think it’s a coincidence that those numbers are the same,” Wieder said. “Abortion is a winning issue.”

Political observers say it’s likely Beshear would have won for other reasons — his overall popularity, his advantage as the incumbent, and his management of crises in his first term including the Covid-19 pandemic and devastating tornadoes and deadly flooding.

But the abortion issue — in particular, the ad featuring Duvall — deepened the contrast between Beshear and Cameron.

While Beshear has said he supports abortion access previously conferred by Roe v. Wade, as he ran for re-election he stressed that the law contains no exemptions for rape or incest, calling it “cruel.”

Cameron, who has defended Kentucky’s laws, was left struggling to explain his stance, giving conflicting responses to the issues raised in the ad. And that worked to Beshear’s benefit, said Danny Briscoe, a long-time Democratic consultant from Louisville.

“You can’t say she won the campaign for him but you can say she played an awfully valuable role,” Briscoe said of Duvall. “They put the ball in Cameron’s court and he never really got rid of it.”

UPDATE, Nov. 13: Polls indicated the ad would be the most effecitve in moving voters from Cameron to Beshear, campaign manager Eric Hyers told Politico: “It cemented and locked in where the race was and made it so that it was going to be very, very difficult — if not impossible — for him to get to a majority because people were so repulsed.” He also said voters who moved the most were older Republican, non-college educated men in rural areas, Madison Fernandez reports.

Tres Watson, a GOP campaign consultant, said Republicans who once confidently campaigned on ending abortion are in an awkward spot now that it is effectively banned in 14 states and restricted in 11 more.

“I think it’s a new reality,” said Watson, a co-host of the Kentucky Politics Weekly podcast. “I don’t think the general public has changed. Who’s on the offense and who’s on the defense have changed.”

Most Americans oppose the decision overturning Roe v. Wade and continue to support at least some measure of access to abortion, according to a Marist College poll in April.

Addia Wuchner, executive director of Kentucky Right to Life, which endorsed Cameron through its Victory PAC as “an unwavering defender of Kentucky’s pro-life laws,” noted that Republicans won the other five statewide constitutional offices on the Nov. 7 ballot were won by Republicans and all were endorsed by Right to Life, including Russell Coleman, who will replace Cameron as attorney general.

As for the outcome of the governor’s race in Kentucky, Wuchner said, “We’re still trying to evaluate everything.

Whether the Kentucky General Assembly will consider adding exemptions to the state’s stringent abortion laws remains in question.

Two laws are in in effect: A “trigger law” that banned all abortions once Roe v. Wade was overturned and another that bans abortions after six weeks, before many women realize they are pregnant. Neither law has exemptions for rape or incest and allow abortion only in rare instances to save the life or prevent disabling injury of a pregnant patient.

Beshear called on lawmakers the day after the election to add exceptions for rape or incest, calling Kentucky’s laws among the “most extreme” in the nation.

Rep. Jason Nemes, R-Louisville, filed such a measure only to have it ignored by lawmakers in the 2023 legislative session. “I think our people believe in the exemptions,” he said. “And at some point, we’re representatives of the people, and we have to do what their demands are.”

However, “Exceptions for rape and incest are the minimum,” said the ACLU’s Cooper. “It’s really not enough.” Wieder, with Planned Parenthood, agrees.

She said Planned Parenthood will continue work to educate voters that the decision now rests with state lawmakers. “People think the bans are national,” Wieder said. “They don’t realize it’s their local leaders.”

What's new in Medicare plans? 'Check, check and double check'

Photo illustration by iStock/Getty Images via KFF Health News

By Julie Appleby

KFF Health News

Consumers know it’s fall when stores start offering Halloween candy and flu shots — and airwaves and mailboxes are filled with advertisements for Medicare options. (Editor's note: One of the latest ads plays off a "viewer" saying she's tired of the ads.)

It’s annual open enrollment time again for the 65 million Americans covered by Medicare, the federal health program for older people and some people with disabilities.

From Oct. 15 to Dec. 7, enrollees in either the traditional program or Medicare Advantage plans, which are offered by private insurers, can change their coverage. (First-time enrollees generally sign up within a few months of their 65th birthday, whether that’s during open enrollment season or not.)

There are a few new features for 2024, including a lower out-of-pocket cost limit for some patients taking expensive drugs.

No matter what, experts say, it’s a good idea for beneficiaries to examine their current coverage because health and drug plans may have made changes — including to the pharmacies or medical providers in their networks and how much prescriptions cost.

“The advice is to check, check, and double check,” said Bonnie Burns, a consultant with California Health Advocates, a nonprofit Medicare advocacy program.

But as anyone in the program or who helps friends or relatives with coverage decisions knows, it is complicated.
Here are a few things to keep in mind.

Know the basics: Medicare vs. Medicare Advantage

People in traditional Medicare can see any participating doctor or hospital (and most do participate), while those in Medicare Advantage must select from a specified list of providers — a network — unique to that plan. Some Advantage plans offer a broader network than others. Always check to see if your preferred doctors, hospitals, and pharmacies are covered.

Because traditional Medicare doesn’t cover prescriptions, its members should also consider signing up for Part D, the optional drug benefit, which includes a separate premium.

Most Advantage plans include drug coverage, but make sure before enrolling, because some don’t. These private plans are advertised heavily, often touting that they offer “extras” unavailable in traditional Medicare, such as dental or vision coverage. Read the fine print to see what limits, if any, are placed on such benefits.

Those 65 and older joining traditional Medicare for the first time can buy a supplemental, or “Medigap,” policy, which covers many out-of-pocket costs, such as deductibles and copays, which can be substantial. Generally, beneficiaries have a six-month window after they enroll in Medicare Part B to purchase a Medigap policy.

So, switching from Medicare Advantage back to traditional Medicare during open enrollment can raise issues for those who want to buy a supplemental Medigap policy. That’s because, with some exceptions, private insurers offering Medigap plans can reject applicants with health conditions, or raise premiums or limit coverage of preexisting conditions.

Some states offer beneficiaries more guarantees that they can switch Medigap plans without answering health questions, although rules vary.

Making all of this more confusing, there is a second open enrollment period each year, but it’s only for those in Medicare Advantage plans. They can change plans, or switch back to traditional Medicare, from Jan. 1 to March 31.

Drug coverage has changed — for the better

Beneficiaries who signed up for a Part D drug plan or get drug coverage through their Medicare Advantage plan know there are a lot of copays and deductibles. But in 2024, for those who require a lot of high-priced medications, some of these expenses will disappear.

The 2021 Inflation Reduction Act places a new annual limit on Medicare beneficiaries’ out-of-pocket costs for drugs.

“That policy is going to help people who have very expensive medications for conditions like cancer, rheumatoid arthritis, and hepatitis,” said Tricia Neuman, senior vice president and head of the Kaiser Family Foundation's Medicare policy program.

The cap will greatly help beneficiaries who fall into Medicare’s “catastrophic” coverage tier — an estimated 1.5 million Americans in 2019, according to KFF.

Here’s how it works: The cap is triggered after patients and their drug plans spend about $8,000 combined on drugs. KFF estimates that, for many patients, that means about $3,300 in out-of-pocket spending.

Some people could hit the cap in a single month, given the high prices of many drugs for serious conditions. After reaching the cap, beneficiaries don’t have to pay anything out-of-pocket for their medicines that year, potentially saving them thousands of dollars annually.

It’s important to note that this new cap won’t apply to drugs that are infused into patients, generally at doctor’s offices, such as many chemotherapies for cancer. Those medicines are covered by Medicare Part B, which pays for doctor visits and other outpatient services.

Medicare next year is also expanding eligibility for some low-income beneficiaries to qualify for low- or zero-premium drug coverage that comes with no deductibles and lower copayments, according to the Medicare Rights Center.

Insurers offering Part D and Advantage plans might have also made other changes to drug coverage, Burns said.

Beneficiaries should check their plan’s “formulary,” a list of covered drugs, and how much they must pay for the medications. Be sure to note whether prescriptions require a copayment, which is a flat dollar amount, or coinsurance, which is a percentage of the drug cost. Generally, copayments mean lower out-of-pocket costs than coinsurance, Burns said.

Help is available

In many parts of the country, consumers have a choice of more than 40 Medicare Advantage plans. That can be overwhelming.

Medicare’s online plan finder provides details on the Advantage and Part D drug plans available by ZIP code. It allows users to drill down into details about benefits and costs and each plan’s network of health providers.

Insurers are supposed to keep their provider directories up to date. But experts say enrollees should check directly with doctors and hospitals they prefer to confirm they participate in any given Advantage plan. People concerned about drug costs should “check whether their pharmacy is a ‘preferred’ pharmacy and if it’s in network” under their Advantage or Part D plan, Neuman said.

“There can be a significant difference in out-of-pocket spending between one pharmacy and another, even in the same plan,” she said.

To get the fullest picture of estimated drug costs, Medicare beneficiaries should look up their prescriptions, the dosages, and their pharmacies, said Emily Whicheloe, director of education at the Medicare Rights Center.

“For people with specific drug needs, it’s also a good idea to contact the plan and say, ‘Hey, are you still covering this drug next year?’ If not, change to a plan that is,” she said.

Additional help with enrollment can be had for free through the State Health Insurance Assistance Program, which operates in all states.

Beneficiaries can also ask questions via a toll-free hotline run by Medicare: 1-800-633-4227, or 1-800-MEDICARE.

Insurance brokers can also help, but with a caveat. “Working with a broker can be nice for that personalized touch, but know they might not represent all the plans in their state,” said Whicheloe.

Whatever you do, avoid telemarketers, Burns said. In addition to TV and mail advertisements, telephone calls hawking private plans bombard many Medicare beneficiaries.

”Just hang up,” Burns said.

'Disrupting Addiction: A KET Forum' premieres Monday, July 24, to discuss the work being done to ease this public-health crisis

Kentucky Injury Prevention and Research Center map, enhanced by Kentucky Health News

Kentucky Health News

According to the state's annual Overdose Fatality Report, 2,135 Kentuckians died from a drug overdose in 2022. That was 5 percent fewer than in 2021, but many counties reported an increase in such deaths. 

Kentucky Educational Television is airing a program that includes a panel of survivors, drug-recovery experts and providers about the public-health crisis of addiction and the ongoing work to ease it. 

"Disrupting Addiction: A KET Forum" premieres Monday, July 24, at 8 p.m. ET on KET. It will be aired 21 more times on various days, times and channels through Aug. 9. To see the list of dates and times the program will air go to https:// ket.org/program/ket-forums/. It can also be viewed on the website KET.org.

The panelists include: Jimmy Cornelison, Madison County coroner; Eric Friedlander, secretary of the state Cabinet for Health and Family Services; Jennifer Hancock, president and CEO, Volunteers of America Mid-States; Bryan Hubbard, executive director and chair of the Kentucky Opioid Abatement Advisory Commission in the attorney general's office; Van Ingram, executive director of the state Office of Drug Control Policy in the Justice and Public Safety Cabinet; State Rep. Kim Moser, R-Taylor Mill, chair of the House Health Services Committee; and Dr. Devin Oller, University of Kentucky College of Medicine, primary care and addiction medicine physician. 

The program will also feature reports from Isaiah House Treatment Center; Kungu Njuguna, an attorney who is recovering from alcohol and heroin addiction; and the Estill County Health Department, which now offers a syringe-service program through a mobile clinic after being shut down for several years.

'Understanding autism: A KET Forum' premieres June 27

Autism, which is a complicated and often misunderstood neurological and developmental disorder, will be the subject of a forum on KET at 8 p.m. ET Tuesday, June 27 and on KET2 at 9 p.m. ET Thursday, June 29. The program will be available on demand at KET.org and the PBS app.

Kelsey Starks will host "Understanding Autism: A KET Forum" with experts including doctors, therapists and those affected by what some call "a neuro-difference" to help viewers understand how individuals with autism learn and interact with the world around them. They will also discuss education opportunities and the need for early intervention, and suggest ways to navigate the resources available. The studio guests will be:

• Dr. Gregory Barnes, director of the Norton Children’s Autism Center in Louisville and chair of the Kentucky Advisory Council on Autism

• Dr. Marisa Toomey, developmental pediatrics specialist at UK Children’s Hospital in Lexington

• Melanie West, executive director of Families for Effective Autism Treatment of Louisville

• State Rep. Tina Bojanowski, a special-education teacher in Jefferson County Public Schools and parent of a child with autism

• Scott Brinkman of Louisville, attorney and parent of a child with autism, and former state representative and state Cabinet secretary

• Susan Mills of Lexington, founder and executive director of the nonprofit My Autism Tribe and parent of child with autism

• Tanya Sturgill, autism resource specialist with the Fayette County Public Schools.

The program will also include recorded interviews with Kentuckians who live with autism or work in the field:

• Donovan Blackburn, director of the Appalachian Valley Autism Center in Pikeville

• Cody Clark, Louisville-based autistic adult/creator of “Cody Clark Magic”

• Mary & Kris Vaughn of Prospect, parents of a 16-year-old son with autism

• Patrick Elias, a Western Kentucky University senior and participant in the university’s Kelly Autism Program

• Michelle Elkins-Burckhard, director of WKU’s Kelly Autism Program

• Drew Hardison, participant in the LifeWorks transitional program at WKU

• Joy McAlpine, participant in LifeWorks

• Sarah Webb, participant in LifeWorks

• David Wheeler, executive director of LifeWorks

Medicare Advantage TV ads and other marketing will have to follow new rules aimed at stopping deception of beneficiaries

Cover of report asking Medicare to act

Kentucky Health News

Those incessant ads and phone calls about Medicare, and other marketing devices that the federal government considers deceptive, are about to get makeovers. At least that's what the feds have in mind.

On April 5, the Centers for Medicare and Medicaid Services "finalized a slew of Medicare Advantage marketing reforms for the upcoming 2024 Medicare open enrollment season, including plans to crack down on general television advertisements after concerns over such marketing kicked into high gear last year, Michalle M. Stein reports for Inside Health Policy.

CMS said last fall that it was worried about marketing practices, particularly concerned about TV commercials for Medicare Advantage, which most Medicare beneficiaries now have. Private insurance companies run MA plans, making money by getting a flat fee from Medicare for covering each beneficiary, then controlling costs by limiting claims payments and taking other measures.

"The Senate Finance Committee fanned those flames with a report that alleged bad actors in 14 states were taking advantage of loopholes and lax rules around marketing and enrollment, “badgering seniors on the phone, confusing them on television, and inundating them with mountains of mail,” and noting complaints to CMS doubled between 2020 and 2021.

"Widespread television advertisements with celebrities claim that seniors are missing out on benefits, including higher Social Security payments," the report said, calling the ads deceptive. It urged CMS to act.

CMS said, “The proliferation of certain television advertisements generically promoting enrollment in MA plans has been a specific topic of concern. To address these concerns, CMS is prohibiting ads that do not mention a specific plan name as well as ads that use words and imagery that may confuse beneficiaries or use language or Medicare logos in a way that is misleading, confusing, or misrepresents the plan.”

The proposed regulations would, also require insurers to:

• Notifying enrollees annually and in writing of their ability to opt out of phone calls regarding Medicare Advantage and Part D;
• Explain the effect of an enrollee’s enrollment choice on their current coverage when they make an enrollment decision;
• Simplifying plan comparisons by requiring medical benefits be in a specific order and listed at the top of plans’ Summary of Benefits;
• Ban marketing of savings information based on a comparison of typical expenses for uninsured individuals or the unpaid costs of beneficiaries eligible for both Medicare and Medicaid;
• Limit the use of the Medicare name, logo and card in ads.

Craft says empty chair at table was a 'close family member' who 'was able to overcome the addiction and move on with their life'

A Kelly Craft campaign ad shows tables with an empty chair. After this scene, she says, “As a mother, this is personal to me, because I have experienced that empty chair at my table. This has to stop.”

By Al Cross
Kentucky Health News

For 10 days, Kentuckians have seen and heard this message from Kelly Craft, one of the Republican candidates for governor:

“All across Kentucky, an empty chair. A place missing at the table. Families suffering because fentanyl and other dangerous drugs have stolen our loved ones away. As a mother, this is personal to me, because I have experienced that empty chair at my table. This has to stop. We need leadership. And as your governor, I’ll back up our police and stop drugs at our border. So there’s no spot missing at the family table.”

The 30-second television commercial has left some viewers wondering who formerly occupied that empty chair, when, and what happened to them.

In an interview with Mark Vanderhoff of Louisville's WLKY last week, Craft declined to identify the person and said the ad refers to “a family member that has had an addiction.” Then, in an impromptu interview, Craft told Ricky Sayer of Lexington's WLEX that the family member is living.  

In a statement Sunday to Kentucky Health News, Craft's campaign identified the person as "a close family member" who lived in her household, "battled addiction and went to rehab. By the grace of God, that family member was able to overcome the addiction and move on with their life, but we all know the struggle never ends for a family and remains ongoing."

The statement added, "An empty chair represents a long road of pain, whether caused by the passing of a loved one or years away from the table. It’s insensitive and malicious to think an empty chair implies only death, and shows that those implying such don’t understand the pain caused by the drug epidemic."

That last line could be taken as a reply to Nick Storm of Kentucky Fried Politics, an online newsletter that said Craft's explanation that the family member is still living showed that the ad "is hyperbole," which Webster's Dictionary defines as "extravagant exaggeration." The Oxford Languages Dictionary, which Google uses, calls it "exaggerated statements or claims not meant to be taken literally." The ad makes no specific claim.

Craft, a former ambassador to Canada and the United Nations, told WLKY, “It was very painful at first to be able to open myself up. It's very emotional. But after traveling throughout the state of Kentucky, my pain is minuscule compared to what I'm hearing and that's because we have a crisis in this state.”

In 2021, Kentucky documented a record 2,250 drug-overdose deaths, 15 percent more than 2020, which had 54% more than 2019. Toxicology reports showed that fentanyl was involved in 73%, or 1,639. That was 16% more than the 1,413 overdose deaths involving fentanyl in 2020.

"Ambassador Craft is really putting her finger on one of the most important issues in Kentucky," Kentucky Public Radio Frankfort reporter Ryland Barton told "Kentucky Edition" host Renee Shaw on Jan. 18. "There was some question there, you know, who exactly was she talking about, you know, how close actually is she to this issue?"

That was the central question asked by Kentucky Health News. The written reply from Craft's campaign began, "As a mother, Kelly knows that the pain caused by the drug epidemic affects almost every family in Kentucky. Kelly has dealt with the chaos addiction causes, first hand. She knows what it means to miss a close family member at the dinner table. Kelly knows the pain that is felt as a family member misses holidays, family dinners, church, school, work, and family events as they confront an addiction ravaging their life."

In interviews, Craft has criticized Gov. Andy Beshear for not mentioning the drug problem in his State of the Commonwealth speech to the legislature on Jan. 5. Her latest ad says Beshear and President Biden are "ignoring the border crisis," which she connects with the importation of fentanyl.

Beshear began his weekly press conference Thursday, Jan. 19, by inviting Kentucky communities to apply for "Recovery Ready" certification, which measures their prevention, treatment and recovery support to residents seeking help for drug or alcohol addiction.

Thursday night in London, Craft called drugs the No. 1 issue in Kentucky and possibly in the U.S. That was the first clip from her in Sayer's three-and-a-half minute report on WLEX, which began by saying that Craft was "choosing to keep private part of a story she made public."

University of Kentucky political-science professor Stephen Voss told WLEX, "I think most people seeing the ad likely inferred that she's saying that a family member died, but that's really sort of on the audience. It doesn't say that. She says there's an absent family member. She doesn't say why they're absent. The important thing for the electorate is, she's claiming a special understanding of the policy issue."

Voss, who was a newspaper reporter in Louisiana before becoming a political scientist, defended the reporters' questions: "Once a candidate brings a family member into the debate and tries to use them to try to establish some kind of expertise or some kind of competence or understanding of an issue, then it's hard for election watchers not to demand, 'Who is this family member? What are you actually saying you experienced with them?'"

Analysis: First TV commercial from anti-abortion group has misleading and inaccurate wording, Herald-Leader writer says

Image from TV ad, provided by Yes for Life

The first television spot from the main group supporting the anti-abortion proposal on Kentucky's Nov. 8 ballot "relies on conservative buzzwords and phrases that are aimed at grabbing viewer attention but are ultimately misleading and inaccurate," writes Alex Acquisto of the Lexington Herald-Leader.

The 30-second ad by Yes for Life begins, “Radical, out-of-state activists want to spend your tax dollars on late-term abortions, even up to the moment of birth.”

Taxpayer funding of abortion "is already illegal under Kentucky law and regulated by federal law," Acquisto notes. "The Hyde Amendment bars the use of federal aid programs, like Medicaid, to pay for abortion."

As for “late-term abortions,” the term "typically refers to an abortion at roughly 21 weeks of pregnancy," Acquisto writes. "Rarely, and typically only for medically-necessary reasons, are abortions provided later than that. Late-term abortions 'even up to the moment of birth' is largely a misnomer. In Kentucky last year, 26 of the 4,441 total abortions provided — or about 0.6% — were at 21 weeks of pregnancy, according to the state Office of Vital Statistics. There were no other abortions reported at a later stage of pregnancy in 2021. Of the 18,614 total abortions reported in Kentucky since 2017, 13 were at or beyond 22 weeks of pregnancy."

The spot tells viewers that a “yes” vote for Constitutional Amendment No. 2 is a “reasonable, common sense vote.”

The amendment would place in the state constitution a statement saying that the document shall not be construed to "secure or protect a right to abortion or require the funding of abortion." Its intent is to leave Kentucky abortion law up to the state legislature, and keep state courts from finding in the constitution a right to abortion.

Voters' approval of the amendment would render moot a case the state Supreme Court is scheduled to hear Nov.15, a week after the election.

The lawsuit by abortion-rights supporters challenges the "trigger law" that virtually banned abortion in Kentucky when the U.S. Supreme Court overturned its 1973 Roe v. Wade decision, and another law banning abortion after the sixth week of pregnancy. The immediate question before the court is whether to reinstate an injunction blocking those laws passed by the legislature.

The injunction has been blocked by a Court of Appeals judge. It was issued by Jefferson Circuit Judge Mitch Perry on grounds that the lawsuit was likely to succeed, based on sections of the state constitution that guarantee religious freedom and say Kentuckians have “the right of seeking and pursuing their safety and happiness” and “Absolute and arbitrary power over the lives, liberty and property of freemen exists nowhere in a republic, not even in the largest majority.” Kentucky courts have found in those words a limited right to privacy, which was the basis for Roe v. Wade and similar decisions in other states.

In a news story, the Courier Journal's Deborah Yetter calls the spot's claims "questionable" and writes, "The new ad brings a new level of rhetoric from amendment supporters."

'Youth Mental Health: A KET Forum', about youth suicide and ways to help, will air live Sept. 13 and be repeated and online

One out of seven Kentucky high school students report having seriously considered taking their own life, and suicide is the second leading cause of death for teens and young adults in Kentucky.

Kentucky Educational Television is airing a forum that examines teen and young-adult suicide in the state and how to prevent it.

"Youth Mental Health: A KET Forum," hosted by Renee Shaw, will examine the youth-suicide problem by talking with students, educators and mental-health professionals about the root causes of anxiety and depression. It will also discuss ways to help young people in crisis. 

It premieres at 8 p.m. ET Tuesday, Sept. 13, on KET. It will also be shown Thursday, Sept. 15, at 2:30 a.m. on KET and at 7:30 a.m. on KETKY; and at 2 p.m. Sunday, Sept. 18, on KET.

If you have a question about youth mental health that you would like to see addressed in the forum, send the question to publicaffairs@KET.org. 

After the live forum, KET will air "Facing Suicide," a PBS program that explores the powerful stories of those impacted by suicide, taking us to the frontiers of science, medicine and health policy to show us what we know about suicide and what that knowledge tells us about helping those at risk. "Facing Suicide" will air Tuesday, Sept. 13, at 9 p.m. ET.

After the Kentucky program airs, it will be available for streaming at KET.org and on the PBS video app. September is National Suicide Prevention Month. 

Help is available for anyone who is thinking about suicide or knows someone who is considering it. To get help, dial 988, which is the new suicide and crisis lifeline. The new three-digit mental health crisis hotline offers free, confidential support and is available 24 hours a day.

For more KET programs about mental health and related topics, visit KET.org/mental-health.

Pharmacy benefit managers' group ranked No. 7 in spending for lobbying the General Assembly, after laying out $53,634 for ads

Commonwealth Fund flow chart, amended by Kentucky Health News to include patients and employers

By Al Cross
Kentucky Health News

The lobbying organization for pharmacy benefit managers, the middlemen between insurance companies and drug manufacturers, spent $86,168 in its successful effort to defeat a bill in the recent legislative session that would have reined them in. They prevailed over pharmacists with the help of insurers, who argued that the bill would raise costs.

The Pharmaceutical Care Management Association ranked seventh in spending by lobbying interests in the session that ended in mid-April, mainly because it spent tens of thousands of dollars in television commercials attacking the bill. The ads started the day the bill overwhelmingly passed the House, where a pharmacist-legislator was the sponsor. PCMA said it spent a total of $53,634 on TV, internet and newspaper ads.

The bill got nowhere in the Senate, where President Robert Stivers said "When it got here, we started getting, from business sector and provider sector, various questions and comments about what the overall cost would be to various plans."

Tom Stephens, executive director of the Kentucky Association of Health Plans, cited a state Department of Insurance statement that a family of four would have paid up to $167 more a year for coverage if the bill had passed.

House Bill 457 would have ensured that patients could pick their pharmacy, instead of being required to use one affiliated with a pharmacy benefit manager; increase transparency between insurers and PBMs; and ban PBMs from retroactively denying a pharmacy claim after adjudication, commonly referred to as "clawing back." It passed the House 88-3.

The Federal Trade Commission voted Tuesday to investigate how pharmacy benefit managers affect the cost of prescription drugs and consumers' access to the drugs.

Several other health-care interests, or lobbying groups with interests in health care, were big spenders on lobbying the session, according to their post-session reports. The Kentucky Chamber of Commerce was again No. 1, spending $183,949; the Kentucky Hospital Association was second with $149,046. Third and fourth were the American Civil Liberties Union of Kentucky, whose issues include abortion rights, $128,258, and Altria Client Services (Philip Morris Cos.), $126,793. Insurer Anthem Inc. ranked 10th by spending $70,597.

Other big health spenders were the Kentucky Medical Association, 16th, at $54,044, and HCA Healthcare, 22nd at $48,832. The state Legislative Ethics Commission’s searchable register of lobbyists, employers and lobbying expenses is online at http://apps.klec.ky.gov/searchregister.asp.

TV commercials from aging quarterbacks and others for private Medicare plans don't tell the whole story, such as high deductibles

Joe Namath, in image from Medicare Advantage TV commercial aired in Fall 2020

By Trudy Lieberman

It seems nothing ever changes when it comes to hawking insurance to fill gaps in Medicare coverage. The fervent sales pitches, the misinformation, and the incomplete and deceptive information continue to proliferate.

For the last several weeks I’ve heard ad after ad urging older viewers to call 800 numbers to learn about the latest and greatest Medicare Advantage (MA) plans. Retired football star Joe Namath says you need to “get everything you’re entitled to.” Namath rattles off a bunch of extra benefits MA plans offer – dental, vision, hearing, prescription drug coverage – “all at no extra cost.” He urges viewers to “call the number on your screen now. It’s free.”

These are new benefits the government has let private insurers sell in hope of getting more seniors to leave traditional Medicare for a privatized system. By transferring more costs to seniors, the government saves taxpayers money.

Another commercial promises “free eyeglasses and free rides,” presumably to doctors’ offices. Yet another tells viewers they “may qualify” to get $144 added back to their Social Security benefits. The Medicare Part B premium for 2021 is $148.50, which is, presumably, what the commercial promises to save those who choose the privatized system.

I suspected those ads were misleading and deceptive come-ons, designed to persuade listeners to call. So I made some calls. The 800 numbers lead to an insurance brokerage firm or agency that apparently has a network of licensed agents located around the country. Callers are asked to give their ZIP code and then are transferred to an agent who can give the “free benefits” review.

I have heard close to 100 Medicare sales pitches over the years and know that those free consultations are meant to result in a sale, whether or not the senior needs the insurance or is really getting a better plan.

Seldom is there talk about making sure people are covered for the huge amounts doctors and hospitals sometimes charge and Medicare doesn’t cover. What are the trade-offs, for example, between buying an MA plan, which pays those charges after you satisfy a large out-of-pocket maximum ($6,700 per person next year) or buying a traditional Medigap insurance supplement Plan G, which covers those charges right away? A couple with Medicare Advantage could pay as much as $13,400 a year before their plan would pay for anything!

With so many choices, what’s a consumer to do? I rang up Bonnie Burns, one of the best Medicare consumer advocates in the country, for advice.

“It’s just too complicated,” she said. “No wonder people throw up their hands. That’s why people sign up for an Advantage plan with little or no premium and find out what the costs really are as they use benefits through the year.” She added, “It would be so much easier if Medicare Advantage plans and drug plans were standardized so people could figure this out.”

Congress could do that, but hasn't, resulting in today’s chaotic marketplace. Congress wanted to allow every insurer in the universe to throw something out there so the companies could make money and could entice more people to leave traditional Medicare. The goal was to reduce taxpayer costs, all the while side-stepping any action to control run-away medical costs.

Congress did standardize Medigap policies in the early 1990s because that market was as chaotic and misleading then as the MA market is today. I like to think of that action as the high-water mark of consumer protection, and I have no illusions that anything like it will happen again anytime soon.

One final bit of crucial advice is missing in today’s ads. Even after you enroll in an MA plan, perhaps enticed by a few dollars in savings for a pair of glasses, you can return to traditional Medicare in the future. But in all but four states (New York, Connecticut, Massachusetts, and Maine) state laws prohibit you from buying a Medigap plan without an insurer scrutinizing your health status.

If you have developed a pre-existing condition, you may be ineligible for a Medigap policy. I’ve met many people over the years who bought an Advantage plan, got sick, and needed to go to out of network for treatment. They learned the hard way they were shut out of the Medigap market for good.

Trudy Lieberman wrote this in 2020 for the Community Health News Service.

Anchorman Sam Dick retires at Lexington's WKYT-TV; he went public with his prostate cancer, surely saving the lives of others

Sam Dick goes public with his cancer. (WKYT-TV image Tuesday, from broadcast several years ago)

Sam Dick, a familiar face to millions of Kentuckians over a record 34 years as evening anchor on Lexington television, did his last newscast Wednesday night. Thousands of Kentuckians remembered him as the man who used his own case of prostate cancer as a teachable moment that surely saved lives.

The story began with “Three words from my doctor that changed my life,” Dick said. “We found something.” Soon, he shared his journey, through surgery, follow-up tests and, after the cancer returned, radiation treatments.

“The first few times, I was pretty anxious and a little nervous about it,” Dick said in a story by Garrett Wymer, broadcast Tuesday evening on WKYT-TV. “I definitely said some prayers. But after about five or six days of the radiation, I got more comfortable, and actually, I try to take a nap.”

Wymer reports, “He used his platform to open up a dialogue, talking about the importance of annual prostate exams and early detection. . . . It was personal to Sam even before his own diagnosis. His father, David, passed away after a 17-year fight against prostate cancer. He pushed Sam to get annual exams, starting in his 40s.” David Dick was a former CBS News correspondent who directed the University of Kentucky journalism school.

Going public with his story made Sam Dick a resource for other men battling prostate cancer.

Rusty Parsons told Wymer, “Sam’s response was: ‘This is my phone number. Call me.’ We talked and we talked, and I cried. and he said the words that came out of his mouth was: ‘I’ve been through everything you’re going through. You are normal. There is nothing wrong with you.’”

KET program, airing Monday night and online afterward, explores how to die a better death, with a focus on palliative care

The World Health Organization describes palliative care as

"an approach that improves the quality of life of patients and

their families facing the problems associated with life-threatening

illness, through the prevention and relief of suffering by means of

early identification and impeccable assessment and treatment of

pain and other problems, physical, psychosocial, and spiritual."

A Kentucky Educational Television program will examine some moral questions surrounding death, including how to approach medical treatment when you are at the end of your life. 

The program "Horizon: How to Die a Better Death," is presented by Dr. Kevin Fong, who explores what it means to die a better death and shows how palliative care, when done right, can help individuals achieve that goal by shifting the focus from cure to care.   

Fong talks to medical professionals and people who are near the end of their lives and explores how individuals should approach medical treatment when they are dying.

The documentary will air at at 9 p.m. ET and 8 p.m. CT Monday, June 21; and 4/3 p.m. Thursday, June 24 and Sunday, June 27 at 4/3 p.m. KET program are also available at www.ket.org.

Beshear says new vaccine is 'game changer' and the end of the pandemic is in sight, but masks and distancing are still needed

Margaret Brennan of CBS News interviewed Gov. Andy Beshear on "Face the Nation" Sunday.

By Al Cross

Kentucky Health News

As a new vaccine was released and the coronavirus and Covid-19 kept waning in Kentucky, Gov. Andy Beshear said the end of the pandemic is visible and the third vaccine "is going to be a game-changer."

The Centers for Disease Control and Prevention said the one-shot, easily handled vaccine developed by Johnson & Johnson could be given to anyone over 18, and shipments of it began moving out of the company's distribution center in Bullitt County to locations around the country.

"Johnson and Johnson is going to be a game changer," Beshear said on CBS's "Face the Nation" Sunday morning. "We can fully vaccinate everyone in just one shot . . . and we're going to get tens of thousands of additional vaccines per week, per state. It's just gonna get us to the finish line that much faster."

In a video Sunday afternoon, Beshear said new cases of the virus in the state went down for the seventh consecutive week, with final numbers to come Monday, and vaccinations are going faster than ever. He said that in the current vaccination week, with two days to go, more than 91,191 first doses have been administered, the most yet in a week.

"We're getting these vaccines out faster than the federal government can get 'em to us, and we'll get them to you," Beshear said. "Just make sure that you're patient and don't stop doing what is protecting us right now: Masking up, engaging in social distancing, reducing your contact. We can see the end; the light of the tunnel is getting brighter, and the directions that we're headed are good but we can't quit until we get the job done." 

Daily numbers: Beshear reported only 675 new cases of the virus, the lowest number on a Sunday in almost five months. Testing is down, but so is the percentage of people testing positive; in the last seven days, that figure was 5.02%, the lowest in more than four months.

The seven-day rolling average of new cases, generally the best indicator of the pandemic, fell to 1,094, the first time it has been under 1,100 since Oct. 19. Before the daily number was announced, the state remained 10th in new cases per population, according to a daily compilation by The New York Times.

Hospital numbers were down, except the number of Covid-19 patients on ventilators, which jumped to 118 after dropping to 87 the day before. Covid-19 hospitalizations in Kentucky hospitals totaled 732, down 33 from Saturday, with 187 in intensive-care units, down 22. An unusually large share of the ICU patients, 63 percent, were on ventilators.

The state added 12 more people to the list of people dying of Covid-19, bringing the toll to 4,637. Over the last 14 days, the number of people added to the list after review of cases has averaged 25.4 per day. The state does not issue detailed lists of Covid-19 deaths on weekends.

The state reported a new-case rate of 20.9 per 100,000 residents in the last seven days. Counties with rates more than twice that were Caldwell, 240; Taylor, 61; Lyon, 57.4; Clay, 46.7; and Russell, 42.2. The Caldwell and Lyon numbers appear to come mainly or partly from state prisons.

 

Counties with 10 or more new cases were Jefferson, 180; Fayette, 55; Pulaski, 31; Kenton, 24; Daviess, 16; Boone and Madison, 15; Bullitt, Jessamine and Scott,11; and Lincoln, 10.

National TV: The major premise for Beshear's appearance on "Face the Nation" was his high priority for vaccinating teachers and other school personnel. "We're about to be the first state to fully vaccinate all of our educators," he said, omitting his usual caveat: That doesn't include those who declined a shot.

"For us, this was a workforce issue," Beshear said. "It was development for our children, scholastically, emotionally and socially; and it was about getting back to some form of normal while we were still very careful. We made this call early on, we stuck to it, and no matter what you decide during Covid, some are going to oppose it, but it's about trying to do the right thing, the best thing for your people, and then let the consequences be what they'll be."

Host Margaret Brennan asked why Kentucky is "lagging" in vaccine rollout, at 29th in total vaccinations. Beshear replied, "We don't think that we're lagging," because the state has prioritized first doses. "We believe that we have to be as fast as possible with the first dose, to give people some level of immunity, and as of last week we had used 98.5% of all the first doses provided," he said. "We think differently on the second dose; that is meant for a very specific person, and so we made the decision that if it takes a little longer to get it to them, then we were gonna make sure it gets to them."

Asked about the relief-and-stimulus bill moving through Congress, and Senate Minority Leader Mitch McConnell's criticism of its money for state and local governments, Beshear said, "Every county judge-executive and every mayor across Kentucky, whether Democrat, Republican or independent, they'll tell you they desperately need this assistance."

He added, "This gives us the ability to make up for some of that harm. On the state level, this gives us an opportunity to stimulate our economy without having to borrow or go into debt." It's the federal government that will go further into debt to pay for the $1.9 trillion package. 

Beshear said the nation has a decision to make; "Are we gonna be FDR or are we gonna be Herbert Hoover? Do we want to make the decisions to get us out of this recession more quickly, which benefits every family, Democrat or Republican? But you gotta be bold to do that, and you can't worry about credit, whether it happens under a Democratic president or a Republican president. In the midst of a pandemic, can't we put that aside for just a little but and help all our families out there? I hope so."

Asked about the post-election remark by Sen. Joe Manchin, D-W.Va., that "a radical part of the so-called left" scared off rural voters, Beshear said "Our party, like others, has lots of different people with lots of different views. . . . People are passionate about the views they have, but we also have to be respectful of one another, to make sure that what brings us together isn't who we dislike but it's what we stand for. So when those debates are occurring, if they're actually on issues, then we're moving in the right direction, even if there is disagreement on those issues. I'm highly concerned that what is bringing too many people together in our country is who they dislike and not what they actually stand for."

Sales pitches for Medicare Advantage don't tell the whole story

Joe Namath is perhaps the most familiar spokesperson for Medicare Advantage plans.

By Trudy Lieberman
Community Health News Service

It seems nothing ever changes when it comes to hawking insurance to fill gaps in Medicare coverage. The fervent sales pitches, the misinformation, and the incomplete and deceptive information continue to proliferate.

For the last several weeks I’ve heard ad after ad urging older viewers to call 800 numbers to learn about the latest and greatest Medicare Advantage (MA) plans. Retired football star Joe Namath says you need to “get everything you’re entitled to.” Namath rattles off a bunch of extra benefits MA plans offer – dental, vision, hearing, prescription drug coverage – “all at no extra cost.” He urges viewers to “call the number on your screen now. It’s free.”

These are new benefits the government has let private insurers sell in hope of getting more seniors to leave traditional Medicare for a privatized system. By transferring more costs to seniors, the government saves taxpayers money.

Another commercial promises “free eyeglasses and free rides,” presumably to doctors’ offices. Yet another tells viewers they “may qualify” to get $144 added back to their Social Security benefits. The Medicare Part B premium for 2021 is $148.50, which is, presumably, what the commercial promises to save those who choose the privatized system.

I suspected those ads were misleading and deceptive come-ons, designed to persuade listeners to call. So I made some calls. The 800 numbers lead to an insurance brokerage firm or agency that apparently has a network of licensed agents located around the country. Callers are asked to give their ZIP code and then are transferred to an agent who can give the “free benefits” review.

I have heard close to 100 Medicare sales pitches over the years and know that those free consultations are meant to result in a sale, whether or not the senior needs the insurance or is really getting a better plan.

Seldom is there talk about making sure people are covered for the huge amounts doctors and hospitals sometimes charge and Medicare doesn’t cover. What are the trade-offs, for example, between buying an MA plan, which pays those charges after you satisfy a large out-of-pocket maximum ($6,700 per person next year) or buying a traditional Medigap insurance supplement Plan G, which covers those charges right away? A couple with Medicare Advantage could pay as much as $13,400 a year before their plan would pay for anything!

With so many choices, what’s a consumer to do? I rang up Bonnie Burns, one of the best Medicare consumer advocates in the country, for advice.

“It’s just too complicated,” she said. “No wonder people throw up their hands. That’s why people sign up for an Advantage plan with little or no premium and find out what the costs really are as they use benefits through the year.” She added, “It would be so much easier if Medicare Advantage plans and drug plans were standardized so people could figure this out.”

Congress could do that, but hasn't, resulting in today’s chaotic marketplace. Congress wanted to allow every insurer in the universe to throw something out there so the companies could make money and could entice more people to leave traditional Medicare. The goal was to reduce taxpayer costs, all the while side-stepping any action to control run-away medical costs.

Congress did standardize Medigap policies in the early 1990s because that market was as chaotic and misleading then as the MA market is today. I like to think of that action as the high-water mark of consumer protection, and I have no illusions that anything like it will happen again anytime soon.

One final bit of crucial advice is missing in today’s ads. Even after you enroll in an MA plan, perhaps enticed by a few dollars in savings for a pair of glasses, you can return to traditional Medicare in the future. But in all but four states (New York, Connecticut, Massachusetts, and Maine) state laws prohibit you from buying a Medigap plan without an insurer scrutinizing your health status.

If you have developed a pre-existing condition, you may be ineligible for a Medigap policy. I’ve met many people over the years who bought an Advantage plan, got sick, and needed to go to out of network for treatment. They learned the hard way they were shut out of the Medigap market for good.

What choices have you made for covering Medicare gaps? Write Trudy at trudy.lieberman@gmail.com.

Online program for journalists about covering pandemic Oct. 22

The world’s biggest story in 75 years is also a local story for everyone: the coronavirus pandemic. It has posed special challenges for news organizations at a time when they were already challenged: the politicization of public health, pushback from audiences, confusing data, and pandemic fatigue – among audiences and journalists.

To help journalists with this story, the Bluegrass Chapter of the Society of Professional Journalists will hold an online panel discussion, “Covering the Pandemic,” at 7 p.m. ET Thursday, Oct. 22. The panelists will be:

• Alex Acquisto, health reporter, Lexington Herald-Leader

• Jennifer P. Brown of Hopkinsville, who recovered from Covid-19 and wrote about it in her online newspaper, Hoptown Chronicle

• Ben Sheroan, editor, The News-Enterprise of Elizabethtown, who can speak to the pushback newspapers receive from their coverage of the pandemic

• Brian Neal, news director at Lexington’s WLEX-TV, who will address the fatigue factor experienced by journalists

• Susan Dunlap, executive director of the Office of Public Affairs of the state Cabinet for Health and Family Services, who will speak to the communications challenges of government agencies

The discussion will be moderated by Melissa Patrick, reporter for Kentucky Health News.

There is no charge to attend the program, which will be held via Zoom, but registration to receive the Zoom link is required. To register, send an email to john.nelson24@gmail.com.

The Society of Professional Journalists has stood for improving and protecting journalism since 1909. For more information, see www.spj.org or visit the Bluegrass SPJ Chapter’s page on Facebook.

Health chief goes another round with legislators, pushing back on data questions and answering queries on schools, other topics

By Al Cross
Kentucky Health News

FRANKFORT, Ky. – Republican legislators kept up their questioning of the state's coronavirus data Thursday, and the state health commissioner and Democratic lawmakers pushed back.

Sen. Danny Carroll

Sen. Danny Carroll of Paducah, co-chair of the Program Review and Investigations Committee, was the leading questioner and most outspoken legislator, just as he was at the panel's Aug. 13 meeting, when the committee heard from Dr. Steven Stack, commissioner of the Department for Public Health, and Doug Thoroughman, the state's acting chief epidemiologist.

Carroll kept relying Thursday on Thoroughman's tacit acknowledgement, in response to a Carroll question last month, that the positive-test rate that the state reports daily is not accurate, because of imperfect state and federal reporting systems. Thoroughman also said that the rate is useful for comparison over time because its method of calculation remains the same.

Thursday, Carroll noted that some test results have been delayed for weeks, and asked, "How can we have faith in daily numbers?" He said Democratic Gov. Andy Beshear never includes a disclaimer when giving the figure.

Dr. Steven Stack

Stack replied that while the data is "imperfect," it is "incredibly valuable. He noted that the state's daily report has an asterisk leading to a long footnote explaining how the rate is calculated.

He noted that the rate is an average over the previous seven days, and “I believe it becomes a very useful and accurate measure” for seeing trends. He said his department has undertaken "an unprecedented process" to get enough data for rates for about 80 counties.

Carroll replied, "The public sees the governor on TV talking about cases and positive rate" that changes from day to day . . . There is a stress that is put on our people as a result of these numbers." He quoted Thoroughman as saying that the numbers are not accurate, and said. "From an ethical standpoint, I struggle with the comfort level of putting this information out on a daily basis."

Stack replied, "I’m sorry you have such low confidence . . . " and Carroll interjected, "It’s not me. I hear it from my constituents daily. They’re mad about this."

Stack said he hears from others who are grateful for the information, and "It's possible for people to reach different conclusions from same information."

He added, "I don’t feel my ethics are compromised or challenged. . . . The metrics we use and the way we create them are consistent with the state of the art as best as public-health professionals can do it." He said President Trump uses weekly data on positive tests, and told Carroll, "Your concern might be that the president of the United States is misleading the public."

At another point, Carroll noted that the committee had also asked to hear again from Thoroughman, and asked why he wasn't present. Stack replied, "I’ve got him doing a lot of other work and I’m the commissioner," the person ultimately responsible for answering questions about the department.

Carroll said that was "disappointing . . . were it not for Dr. Thoroughman, I’m not sure we would know now that our positivity rates were off."

Toward the end of the meeting, after he and Stack went back and forth about a medical waiver to exempt a special-needs student from the mask mandate, Carroll boiled over.

He said of the state's reporting, "It’s being used to manipulate our people, to make our people scared, to control our people. It’s not accurate and its portrayed as being accurate."

Essentially repeating what he said at the last meeting, Carroll said, "Half of this state does not believe a word that you all say when it comes to the data." He said "All of this could have been avoided had the administration reached out" to leaders of the legislature's Republican majority about pandemic matters.

Sen. Karen Berg, M.D.

Earlier, Democratic Sen. Karen Berg of Louisville, a physician, complimented state health officials' work and said, “They need us to understand it and trust it” so legislators can tell constituents “We have got our best minds working on it . . . It will never be perfect. . . . My constituents have different reactions from Senator Carroll’s. . . . Our responsibility is to get on board and let’s do the best we can.”

Apparently addressing her colleagues, Berg said health-care providers are scared of the virus, and “You all need to understand . . . this is not the flu, this is not a hoax, this has nothing to do with politics or how you want it to be.”

Rep. Adam Koenig

A moderate voice: Rep. Adam Koenig, R-Erlanger, said health-care providers “deserve more thanks than they’re getting,” but “There’s nothing wrong with asking difficult questions.” He told Stack, “It’s been a wonderful opportunity for you to dispel misinformation. . . . No one up here thinks this is a hoax; this is not a political witch hunt; these are questions we get; there’s a lot of frustration.”

Earlier, Carroll had asked Stack, "Why do we not react the same way to these other diseases that we do to covid-19?"

Stack replied, "It's much more dangerous, everybody’s susceptible, and the sheer numbers . . . It's killing a lot more people," and there is no treatment that works on most patients. "There’s over 190,000 Americans who have died in six months. That way outstrips influenza." 

He said that the ultimate mortality rate for covid-19 will probably be about 1 percent, and if only one-third of Kentuckians got infected in a year's time, and 1% died, "That’s 15,000 Kentuckians. . . . That’s why it’s getting so much attention."

Death data: Rep. Lynn Bechler, R-Marion, the other co-chair, asked Stack about the recent notice from the Centers for Disease Control and Prevention that only 6 percent of covid-19 fatalities had no other health conditions that could have contributed to their deaths.

"I didn’t think it was newsworthy, quite frankly," Stack said, "because what we have said all along is that the most vulnerable population is people over 60 or 65 and with chronic medical conditions."

Bechler asked if it was "reasonable to suspect that 94 percent of deaths in Kentucky have underlying conditions." Stack said, "It could be even higher," since Kentucky ranks very high in chronic medical conditions.

Sen. Steve West, R-Paris, told Stack that "a lot of Kentuckians are wondering" about the death rate.

Stack replied, "The question is, how do we assign the immediate cause of death?" He said it's possible that people who have died of covid-19 "would have died in six months anyway" from another condition, but the state "follows the long-established norms we use for any other disease case."

In one of his written responses to questions asked at the last meeting, Stack said, "For death certificates for which the cause of death is not clear as to the contribution of covid-19, or appears to incorrectly include or exclude covid-19 as contributory to the cause of death, the committee reviews patient medical records, discusses the information available, and reaches consensus opinion on whether covid-19 is appropriate for inclusion or exclusion." 

He said the committee had reviewed 41 deaths through Sept. 8 and found that 17 had been removed from the covid-19 list. Through that date, the state had reported just under 1,000 covid-19 deaths.

Sen. Whitney Westerfield

In another written response, to a question posed by Sen. Whitney Westerfield, R-Hopkinsville, Stack said the positive-test rate "is more challenging to make precise due to variable timing of sample collection vs. test-result reporting and due to longstanding limitations in test-reporting policies, processes, and technologies. However, when these limiting variables stay constant, and data are averaged over a period of time, this metric is very helpful for trending purposes."

Asked how long health officials keep contact-tracing data, and whether it is being used for any purpose other than to trace contacts, Stack said, "Basic information is gathered; name, address, phone number, e-mail, etc. Local health departments and Department for Public Health epidemiologists, disease investigators and limited supervisory personnel have access to this. This data is not used for any other purpose other than to trace contacts. Privacy and data security standards are well established and maintained."

Schools: Westerfield asked Stack if he had "any information indicating a return to in-person schooling" before Sept. 28, the date Beshear has recommended.

Stack said they are sticking to that date, and wanted the extra time to learn from the experience of other states. He said he and Beshear are "working on number of things to announce Monday." They have indicated that will include county-level data to guide local decisions.

He said fans are being allowed in stadiums, with strict limits, because "the public demands to be in those stadiums. . ..  Going into a stadium in the middle of an epidemic is not a good idea." He said one stadium wanted 18,000 fans, "which means 600 infected people, shouting and screaming," and people in VIP suites. He estimated that could result in nine to 20 hospitalizations per game, and two deaths.

“We certainly can’t live in fear and not get back to some activities, but we can’t be reckless and careless about it, Stack said. “You could just turbocharge an epidemic,” especially in a major city like Louisville.

In a written question from the last meeting, Westerfield asked if "school data related to abuse/dependency/neglect referrals, substance use [and] behavioral health referrals [is] weighed against covid data when making the recommendations and orders related to schools."

Stack replied in writing, "These are all public-health issues. Social-emotional status of students, food insecurity, drug overdoses, child abuse, etc. all weigh on the minds of public health. Balancing these issues with the effects of a deadly virus that spreads so rapidly presents challenges. However, death or long-term health impacts on individuals from this virus cannot be reversed. Currently, these unintended consequences of managing covid-19 are not contemporaneously measureable as [are] individuals diagnosed with covid and any associated deaths. Data is being collected on abuse/neglect as well as for overdose deaths and other behavioral health impacts. The use of medication-assisted therapy, telehealth and other tele-visitation put in place since the very early stages of covid-19’s entrance into Kentucky has been very helpful. The assessment of the full consequences of covid-19 and impact of the measures taken to minimize the impact on individuals and the economy will be measured and studied for years to come."

A video of the committee meeting is on the KET website.