Chapter 9

Fake healthcare plans

Posted on February 16, 2019 by Melissa Hart

If you’re looking online for health insurance, there are lots of results that seem to offer good choices. But dishonest companies are literally counting on you being confused by all those choices. So, before you sign up and pay, take steps to know you’re getting exactly what the plan advertised. Otherwise, fake “coverage” can leave you exposed to substandard benefits and costly payments.

For example, according to the Federal Trade Commission, a Florida-based company, Simple Health Plans, LLC, allegedly tricked consumers into believing its plans offer comprehensive coverage and are compliant with Affordable Care Act (ACA) standards. The company allegedly lured people in through lead-generation sites, using logos of well-known health insurance providers to make itself look credible. Simple Health asked for personal information on the site, followed up with phone calls, and pitched what it said were affordable, comprehensive, ACA-qualified plans with low or no co-pays or deductibles.

But once consumers signed up — often at premiums as high as hundreds of dollars per month — the FTC says they did not get anywhere near the full coverage Simple Health promised, and the benefits were not ACA-qualified.

For more information, click here.

Teaching Suggestions

  • Ask students if they or any of their friends and relatives have received sham health insurance plans calls. If so, how did they handle such calls?
  • Help students understand that two best-known and legitimate sources of the government health insurance are Medicare and Medicaid.

Discussion Questions

  1. What are some ways to protect yourself against false health care plans?
  2. Why is it important to learn the difference between health insurance and medical insurance discount plans?
Categories: Chapter 9, Frauds and Scams, Health Insurance | Tags: , | Leave a comment

New Medicare cards are on the way

Posted on August 5, 2017 by Melissa Hart

Changes are coming to your Medicare card.  By April 2019, your card will be replaced with one that no longer shows your Social Security number.  Instead, your card will have a new Medicare Beneficiary Identifier (MBI) that will be used for billing and for checking your eligibility and claim status.

Having your Social Security number removed from your Medicare card helps fight medical identity theft and protects your medical and financial information.

Here are some common Medicare scams relating to the new cards:

  • Someone calling, claiming to be from Medicare, and asking for your Social Security number or bank information.
  • Someone asking you to pay for your new card.
  • Someone threatening to cancel your benefits if you don’t provide information or money?

For more on the new changes to your Medicare card, visit Centers for Medicare & Medicaid Services.  And report scams to the FTC.

For more information, click here.

Teaching Suggestions

  1. How do you think this change will affect patients? You?
  2. Replacing Social Security number with Health Insurance Claim Number will cost millions of taxpayers dollars. Do you think it is worth the expense?

Discussion Questions

  • What is the biggest reason the Social Security is taking the Social Security Number off of Medicare cards?
  • How will the new system affect people with Medicare?
  • Who will be the affected stakeholders?
Categories: Chapter 9, Health Insurance, Retirement Planning, Wise Shopping | Tags: , | Leave a comment

What If Social Security Denies Your Disability Benefits?

Posted on August 6, 2016 by Melissa Hart

If Social Security denied your disability benefits, you can file an appeal online, even if you live outside of the United States.

The online appeals application is simple, convenient and secure, guiding you through every step of the process.  From outlining your rights to an appeal, to publications on the appeals process, a fair review of your Social Security is right at your fingertips.  The online application even allows you to upload supporting documentation, like treatments, doctors, and medical reports, as well as an option to save your submissions.

Submitting all the necessary documents will save time and can help return a faster decision.  Here are some things you’ll need when ready to submit an appeal:

  • Doctors, hospitals, medical treatments, and tests since you last gave medical information to Social Security,
  • Medicines you are currently taking, and
  • Changes in your medical conditions, daily activities, work and education

For more information, click here.

Teaching Suggestions

  • Ask students if they know someone whose disability benefits were denied? If so, how was the problem resolved?
  • What can you do if Social Security benefits are not sufficient to support your family?

Discussion Questions

  1. Does Social Security provide work incentives that allow people to work and still receive their disability benefits?
  2. Does Social Security provide benefits for partial disability or short-term disability?
  3. How does Social Security define disability?
Categories: Chapter 9, Disability Insurance | Tags: , , | Leave a comment

Fighting Against Medicare Fraud and Abuse

Posted on September 30, 2015 by Melissa Hart

Don’t Stand by…..Speak Up!

Have you ever witnessed something that you knew was wrong and wondered if you should report it?  Did you want to say something, but didn’t because you were afraid of negative consequences?  Don’t be afraid, because there are federal laws to protect you.   Indeed, as a bystander, you can play an essential role in preventing violence, wrongdoings, and fraud.

Reporting information or activity that you suspect is illegal, dishonest, or false is your right.  Reportable violations could be abuse of authority, gross waste of funds, a specific danger to public health or safety, or gross mismanagement.

Social Security’s programs were originally created to serve the American public, and 80 years later they still provide critical support to people of all ages.  As good stewards of the tax dollars, Social Security Administration designs its systems to protect against fraud, waste, and abuse.  However, its systems can’t catch everything.  And that’s where you can help.  Report wrongful acts and protect lives as well as taxpayers’ dollars.

For more information, click here.

Teaching Suggestions

  • Ask students to comment on the statement: “Nearly 70 percent of consumers believe the Medicare program would not go broke if fraud and abuse were eliminated.”
  • What would YOU do if you suspected fraud or other wrongdoings, including wasting taxpayers’ dollars?

Discussion Questions

  1. Social Security Administration (SSA) will pay about $887 billion in Social Security benefits to almost 60 million individuals in 2015. What specific tools the SSA uses to fight fraud and protect taxpayers’ dollars.
  2. How does the SSA investigate people who provide false, incomplete, or inaccurate information to defraud the government?
Categories: Chapter 9, Frauds and Scams, Health Insurance | Tags: , | Leave a comment

I’m Young and Healthy–Is an HDHP Right for Me?

Posted on September 26, 2015 by Melissa Hart

“I’ve been told a high deductible health plan (HDHP) is a good choice for my situation and that it might save me some money.  Can you explain this to me.”

This Forbes article provides answers to the questions that many people–especially younger people–have about high deductible health insurance policies.  At the beginning, the author, Christina LeMontagne, points out that high deductible policies are a great option for healthy people, but may not be right for everyone.  She also describes what a high deductible health plan is, who can benefit  from HDHPs, and how they can save you money.

For more information, click here.

Teaching Suggestions

You may want to use the information in this blog post and the original article to

  • Reinforce what a high deductible health plan (HDHP) is.
  • Stress the fact that while an HDHP may save you money, there are risk involved if you choose this type of policy.

Discussion Questions

  1. What are the advantages of an HDHP plan?
  2. What are the disadvantages of an HDHP plan?
  3. Under what circumstances would you choose an HDHP plan?
Categories: Chapter 9, Health Insurance | Tags: , , | Leave a comment

Ticket to Work Program

Posted on September 19, 2015 by Melissa Hart

What is the Ticket to Work Program?

Social Security’s Ticket to Work program supports career development for Social Security disability beneficiaries age 18 through 64 who want to work.  The Ticket program is free and voluntary and it helps people with disabilities progress toward financial independence.

The Ticket program is a good fit for people who want to improve their earning potential and are committed to preparing for long-term success in the workforce.  Ticket to Work offers beneficiaries with disabilities access to meaningful employment with the assistance of Ticket to Work employment service providers called employment networks.  If you are ready to go to work, there are people ready and waiting to help you.

For more information, click here.

Teaching Suggestions

  • Ask students if they know someone who is disabled. Is he/she receiving any benefits from Social Security?  Have they heard of the Ticket to Work program?
  • Earning a living through employment is not something everyone can do. How does one decide whether to seek help from Ticket to Work service providers?

Discussion Questions:

  1. People are more likely to lose their incomes due to disability than death. How does the Social Security Administration define disability to qualify for benefits?
  2. More than 80 percent of working Americans don‘t have disability income insurance or are not covered adequately.  How can Ticket to Work program help these people?
Categories: Chapter 9, Disability Insurance | Tags: , , | Leave a comment

The Supreme Court, Health Care, and You

Posted on July 25, 2015 by Melissa Hart

On June 26, 2015, the Supreme Court made an important decision about the Health Insurance Marketplace keeping           quality, affordable coverage for millions of Americans.  The Supreme Court’s decision confirmed that if you qualify, you can receive financial assistance, including premium tax benefit to make coverage more affordable no matter where you live.

On average, consumers enrolled in the Marketplace are receiving $3,260 per year in tax credit, or $272 each month.

About 8 in 10 consumers could find coverage for $100 or less with tax credit through the Marketplace.

If you don’t have health insurance, see if you can get health coverage for 2015.  You may qualify for a Special Enrollment Period due to life change, such as marriage, having a baby, or losing other coverage.  Open enrollment for 2016 starts on November 1, 2015.

For more information, click here.

Teaching Suggestions

  • Ask students if anyone in their family is affected by the Supreme Court ruling, and if so, how?
  • Ask students to prepare a summary of the major provisions of the Affordable Care Act.

Discussion Questions

  1. Why is it important to inform the Marketplace about any changes to your household, income, and insurance status?
  2. If you have health insurance through your employer or purchased it on the individual market, does the Supreme Court ruling impact you?
Categories: Chapter 9, Health Insurance, insurance, Wise Shopping | Tags: , , | Leave a comment

CMS Proposes Rule to Strengthen Managed Care for Medicaid and CHIP enrollees

Posted on July 11, 2015 by Melissa Hart

On May 26, 2015, the Centers for Medicare and Medicaid Services (CMS) proposed to modernize Medicaid and Children’s Health Insurance Program (CHIP) managed care regulations to update the programs’ rules and strengthen the delivery of quality care for beneficiaries.  This proposed rule is the major update to Medicaid and CHIP managed care regulations in more than a decade.  It would improve beneficiary communications and access, provide new program integrity tools, support state efforts to deliver higher quality care in a cost-effective way, and better align Medicaid and CHIP managed care rules and practices with other sources of health insurance coverage.  Overall, this proposed rule supports the agency’s mission of better care, smarter spending, and healthier people.

For more information, click here.

Teaching Suggestions

  • Ask students to visit the CMS.gov website to learn how the healthcare delivery landscape has changed and grown substantially since 2002.
  • Ask students how CMS might strengthen the quality of care provided to beneficiaries.

Discussion Questions

  1. Why is the CMS proposing new rules to strengthen managed care for Medicaid and CHIP enrollees?
  2. How does the CMS plan to modernize Medicaid and CHIP regulations?
Categories: Chapter 9, Health Insurance | Tags: , , | Leave a comment

5 Ways To Become An Informed Medicare Consumer

Posted on July 8, 2015 by Melissa Hart

Each day, you make important choices about your finances, health, privacy, and more.  Medicare has 5 things you can do to help you become an informed Medicare consumer.

  1. Know your rights. As a person with Medicare, you have certain rights and protections designed to help protect you and make sure you get the health care services the law provides.
  2. Protect your identity. Identity theft happens when someone uses your personal information without your consent to commit fraud or other crimes.  Keep the following information safe:
    • Your name
    • Your Social Security Number (SSN)
    • Your Medicare Number (or your membership card if you’re in a Medicare Advantage or other Medicare health plan)
    • Your credit card and bank account numbers
  1. Help fight Medicare fraud. Medicare fraud takes money from the Medicare program each year, which means higher health care costs for you.  Learn how to report fraud.
  2. Get involved with other seniors with the Senior Medicare Patrol (SMP). The SMP educates and empowers people with Medicare to take an active role in detecting and preventing health care fraud and abuse.
  3. Make informed Medicare choices. Each year during the Fall Open Enrollment Period (October 25-December 7), review your plan to make sure it will meet your needs for the following year.  If you are not satisfied with your current plan, you can switch during the Open Enrollment Period.

For more information, click here.

Teaching Suggestions

  • Ask students to prepare a list of medical expenses that Medicare does not cover.
  • Ask students to check out the Centers for Medicare and Medicaid Services (CMS) videos for tips on preventing Medicare fraud and see how seniors are learning to stop, spot, and report fraud.

Discussion Questions

  1. Why is it vital to fight against Medicare fraud?
  2. Why is it important to review your health care plan during the Fall Enrollment Period?
Categories: Chapter 9, Frauds and Scams, Health Insurance | Tags: , , | Leave a comment

New Health Discovery? The Doctor Oz Effect

Posted on June 6, 2015 by Melissa Hart

In 2015, Lindsey Duncan and the companies he controlled have agreed to settle Federal Trade Commission charges that they deceptively touted the supposed weight-loss benefits of green coffee bean extract through a campaign that included appearances on The Dr. Oz Show, The View, and other television programs.

Under the FTC settlement the defendants are barred from making deceptive claims about the health benefits or efficacy of any dietary supplement or drug product, and will pay $9 million for consumer redress.

The FTC charged that Duncan and his companies, Pure Health LLC and Genesis Today, Inc. deceptively claimed that the supplement could cause consumers to lose 17 pounds and 16 percent of their body fat in just 12 weeks without diet or exercise, and the claim was backed up by clinical study.  In September 2014, the FTC settled charges against the company that sponsored the severely flawed study that Duncan discussed on Dr. Oz show.

For additional information, click here.

Teaching Suggestions

  • Prepare a list of activities individuals can do to stay healthy and maintain a healthy weight.
  • Choose a current issue of Consumer Reports, Money, Kiplinger’s Personal Finance, or other magazines and summarize an article that relates to losing weight.

Discussion Questions

  1. How can you reduce personal health care costs, including losing weight?
  2. Why is it important for consumers to carefully evaluate products?
  3. What are the keys to successful weight loss?
Categories: Chapter 9, Frauds and Scams | Tags: | Leave a comment

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