Final answer:
Beneficiary complaints can be triggered by lack of consent for enrollment, receiving incorrect benefit information, issues with enrollment or disenrollment, and being misled about in-network providers. These are reflective of larger healthcare market issues like adverse selection and moral hazard.
Step-by-step explanation:
Examples of what can trigger a beneficiary complaint include situations where a beneficiary:
- Did not consent to enroll in the plan.
- Received incorrect plan benefit information or were dissatisfied with plan benefits.
- Had enrollment/disenrollment issues such as disenrollment/cancellation requests, late enrollment penalties, or loss of entitlement.
- Were misled about which providers were in-network.
These examples are tied to broader issues in healthcare insurance markets such as moral hazard, adverse selection, and the effects of legislation like the Patient Protection and Affordable Care Act (ACA or Obamacare). Adverse selection, in particular, refers to when riskier individuals are more likely to buy insurance, making it more expensive if healthier individuals opt not to purchase coverage. These healthcare insurance issues can potentially contribute to complaints from beneficiaries regarding their experiences with Medicare, Medicaid, or other fee-for-service plans.