States Seek More Insurance Authority

The National Association of Insurance Commissioners has published recommendations that would give state agencies more regulatory authority over the sales and marketing of Medicare Advantage and Medicare prescription-drug plans if passed by Congress. The committee that developed the proposals in a so-called white paper already has been successful with two issues included in a recent Medicare act.

Since the enactment of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), a number of troubling problems and abuses in the marketing and sales of Medicare private plans have been reported to the state insurance commissioners.

The MMA included provisions that prohibited state regulators from holding plans accountable for their marketing practices, the acts of their agents or from providing assistance to consumers enrolled in Medicare private plans.

"State insurance regulators firmly believe that limiting the states' regulatory authority over Medicare private plans has severely hurt consumers and has preempted the states from enforcing their laws regarding unfair trade practices laws," said NAIC President and Kansas Insurance Commissioner Sandy Praeger. "In many cases, the states have been unable to address abuses in marketing and sales practices because they cannot properly assist consumers who file complaints about a plan sponsor."

America's Health Insurance Plans, known as AHIP, which represents insurance companies such as Aetna(AET Quote) and UnitedHealth Group(UNH Quote), did not respond to a request for comment.

Wisconsin Insurance Commissioner Sean Dilweg, chairman of the NAIC senior issues task force, provided copies of complaints received by his office, mainly regarding senior citizens unknowingly agreeing to buy Medicare Advantage plans.

One case involved a woman with dementia. Dilweg said that, unlike with Medigap, the state insurance commissioners do not have regulatory oversight. He said he is dissatisfied with the current situation in which he must, as commissioner, refer residents with cases of abuse to CMS.