Medicare and Elder Fraud

It’s Medicare open enrollment season, which means that more than 60 million Americans over the age of 65 have within their grasp a fat, softcover book, Medicare & You handbook, that is likely destined for the recycling bin. According to research from the Kaiser Family Foundation (KFF), 71% of Medicare beneficiaries didn’t compare plans during the 2018 Open Enrollment Period — and the numbers look far worse for those over the age of 85, those with lower incomes, and also for people of color.

After reviewing the 128-page Medicare & You handbook, the problem may be that there is just too much information and choice within the program. In 2021, most Medicare beneficiaries are faced with reviewing 33 Medicare Advantage plans and 30 Part D stand-alone prescription drug plans. One common theme among behavioral scientists is something called “overchoice,” which is the phenomenon of overload you may experience when you are staring at the more than 250 items on the 21-page Cheesecake Factory menu.

According to research, overchoice has been associated with unhappiness, decision fatigue, going with the default option, and choice deferral which is avoiding making a decision altogether. Given how important health insurance is, the complexity of the program adds to the burden that we are putting on beneficiaries.

Additionally, because Medicare is so confusing, it is an area that is ripe for elder financial abuse. There is evidence that as people age, they often become targets of scams. The reason is twofold: many older Americans have ample savings that fraudsters can tap and they are at a time in their lives when changes in their thinking processes make it harder to make financial decisions or to recognize scams.

The Consumer Financial Protection Bureau (CFPB) warns that “Neighbors, caregivers, professionals, and even family or friends may try to take advantage of people as they age. They may take money without permission, fail to repay money they owe, charge too much for services, or not do what they were paid to do. These are examples of elder financial abuse.”

So, what’s the answer? The CFPB recommends keeping in touch and staying involved with your loved one’s financial matters as one of the best ways to help prevent abuse. Medicare Open Enrollment may be an ideal time to start a broader conversation about your loved one’s financial life and may also be a good opportunity to take a more detailed look at what’s going on, so that you can identify important red flags.

We need to add Medicare planning to the list of financial issues, like estate planning, that families need to address together. Someone needs to take the lead and use the Medicare Plan Finder to compare plans and select what is right for your loved one. Here’s a quick cheat sheet on the breakdown of Medicare:

Part A (Hospital Insurance):

• Inpatient care in hospitals

• Skilled nursing facility care

• Hospice care

• Home health care

Part B (Medical Insurance):

• Services from doctors and other health care providers

• Outpatient care

• Home health care

• Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)

• Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)

Part D (Drug coverage): Private insurance companies run plans that follow rules set by Medicare to help cover the cost of prescription drugs, including many recommended shots or vaccines.

After even a cursory review, you may be tempted to outsource the process. As with all financial advice, before you pay up for professional help, understand what brokers or agents are selling and how they are compensated.