Abuse cited as insurer halts sales to seniors

State is told of misleading tactics

Carmen Pola said she was deceived into buying an EverCare health plan.

One of the nation's largest health insurers has stopped marketing an insurance plan to Massachusetts senior citizens with disabilities after state officials received dozens of complaints that the company was using abusive and misleading sales tactics.

UnitedHealth Group Inc. suspended marketing of a private Medicare plan, called the Evercare Special Needs Plan for People with Limited Income, earlier this week after meeting with officials from the state Medicaid and elder affairs offices. About 3,000 state residents receive coverage through the plan.

Senior citizen advocates said some sales representatives refused to leave people's homes without getting a signature on a policy. Others misrepresented the plan, they said, claiming it would pay for care that is actually not covered. In addition, the advocates said, some agents repeatedly called seniors, despite requests from younger family members that they stop.

"This is just out of control," said Al Norman, executive director of Massachusetts Home Care, an umbrella group for 30 nonprofit agencies that assist seniors. "It shouldn't be happening. These brokers are using high-pressure tactics, bait-and-switch, and intimidation. They were inappropriately pushing people into a product they didn't want and didn't understand."

The special needs plan covers all basic healthcare, plus additional benefits such as coordination of care from multiple specialists.

Carmen Pola, 69, of Roxbury, said an insurance agent selling the Evercare plan came to her house and persuaded her to sign up for the coverage even though she was satisfied with her Harvard Pilgrim Health Care insurance. As a result, Pola said, her copayments for doctor visits increased from $15 to $25, and instead of $5 copayments for prescription medications, she is now required to pay full price.

"My husband went to Walgreens pharmacy to get insulin for his diabetes, and it was $200 under this new plan," said Pola. "I panicked. I felt responsible. I found myself begging for a bottle of insulin."

Richard Segan, Evercare's executive director for Massachusetts, Rhode Island, and Maine, said the company is investigating the complaints.

"We have had complaints of feedback related to some brokers perhaps pushing or being overly aggressive," Segan said. "We take them very seriously. We want to make sure there are no instances of high-pressure sales."

The Evercare plan is intended for seniors who have significant disabilities, such as long-term illnesses. It has been sold in Massachusetts since 2006. Most enrollees are so-called dual-eligibles - they qualify for benefits under both the federal Medicare plan for people over 65 and the joint federal-state Medicaid program for low-income and disabled people. It is one of a variety of private healthcare plans that have proliferated nationwide in recent years as the federal government has promoted private alternatives to traditional Medicare. Health insurers have responded by devising ever-more specialized plans targeting specific groups.

UnitedHealth Group, based in Minnetonka, Minn., operates in all 50 states and is predicting $81 billion in revenue this year. Evercare is part of the company's Ovations division, which sells health plans to seniors.

Norman said he has been receiving complaints about Evercare from his member agencies for about a year. Shine, the state program that provides healthcare information to seniors, has received similar complaints for at least six months, said Marion Aspinall, Shine's director.

Greater Boston Legal Services, which provides legal advice to people in need, has also heard complaints about Evercare.

"We've heard of cases where brokers have signed up people who don't speak English," said Donna McCormick, managing attorney for Greater Boston Legal Services. "They didn't tell seniors that there are networks, and they may not be able to see their own doctors. They promise that taxi rides to doctor's offices and bingo games are part of the program. Some said they were from Medicare itself and that it was going under and they needed to sign up."

Norman said he met with officials from Evercare July 1, who promised little, but said the independent brokers were only authorized to sell the plan for special-needs patients. Evercare has a similar Medicare plan that is marketed to seniors without special needs.

On Tuesday, company officials met with state officials and said they would temporarily halt broker sales of the special needs plan starting Aug. 1. Segan, the Evercare official, said the company would also review its program to educate and certify independent insurance agents.

In addition, he said agents might be confused because the insurance plans sold in Massachusetts are different from those in other states. The company sells four different plans in Massachusetts. Evercare said it plans to eventually restart broker sales, but not before Jan. 1.

Seniors or family members with questions or complaints about health insurance plans can call Shine at 800-243-4636.

Jeffrey Krasner can be reached at krasner@globe.com.