Beware of Medicare Fraud

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Lewis and Bertie must have felt like they had just bought “a pig in a poke,” which led me to examine the origin of those words.

I learned that a poke is a small sack, the origin of the word pocket. More than 500 years old, the word represented the type of bag that might be used to carry a piglet to market. But that pig, in reality, might prove not to be a pig at all if an unscrupulous merchant tried to cheat someone by substituting some other animal. (Uncovering the scam would be “letting the cat out of the bag.”)

Hence comes the advice, “Don’t buy a pig in a poke,” or don’t buy a pig until you have actually seen it. Or if you’re like me and aren’t exactly wheeling and dealing with live pigs every day, the relevant meaning of ‘pig in a poke’ is an offering or deal that is accepted without being fully examined or understood.

But I suspect Lewis and Bertie, Farm Bureau members in the Upper Cumberland area, aren’t too interested in the analysis of this “pig in a poke” phrase. They’re just glad they uncovered their pig quick enough to discard it and return to something with which they were completely familiar.

Lewis and Bertie are not unlike most of the nearly 56,000 seniors who trust TRH Health Plans, the affiliate health-care company of the Tennessee Farm Bureau, for their Medicare Supplement coverage. They’re concerned about cost and always looking for responsible ways to stretch their dollars.

“This man came along, and he said that everything would be so much cheaper,” recalls Bertie, 78. “So we took it out and went to get medicine, and they wouldn’t pay for that. Then we went to the hospital, and they wouldn’t take it – said it wasn’t in their network.”

Lewis and Bertie, who had coverage with TRH Health Plans for a long time, decided to cancel it and purchase an Advantage plan from a major, multistate health insurer. Within two weeks, they had determined it wasn’t what they had expected.

“Right then we turned around and went back to TRH,” said Bertie. “We tried to get out of it as quick as we could.”

Fortunately for Lewis and Bertie, they were able to get back into a Medicare Supplement from TRH Health Plans without being subject to pre-existing conditions or going through underwriting (where previous health conditions could have even led to their being rejected for coverage). It’s important to note, however, this is not always the case – underwriting and no coverage for pre-existing conditions for a certain time period are applicable in many situations where an individual seeks to jump from an Advantage plan to a Medicare Supplement plan.

So Bertie has a bit of advice for Tennessee seniors, many of whom will soon be bombarded with offers from various Medicare Advantage plans.

“It’s important, and you’ve got to look out. We should have checked before we took it out,” she advises. “You just can’t believe everybody.”

When it comes to looking for coverage to supplement Medicare, Lewis and Bertie probably won’t look again beyond their local Farm Bureau office, where the folks are “so nice and friendly and seem to understand.” No pigs in a poke there. Just a TRH Health Plans representative who will do her best to make certain you have a product you understand from an organization you know and trust.

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