Spotlight on Advertiser: Medicare and Me: How Medicare Protects You

Leah Kari

Leah Kari, licensed insurance agent and retired pharmaceutical representative

Medicare’s marketing rules ensure that you are in charge. CMS, the Centers for Medicare & Medicaid Services, administers the Medicare program. CMS annually approves all Medicare Advantage and stand-alone prescription drug plans in the United States. CMS regulates the marketing activities of insurance carriers, third-party marketing organizations, and agent/brokers to protect Medicare consumers from misleading marketing practices.

Medicare requires plans and their agents/brokers adhere to rules governing when and how they may market their plans to you and conduct the enrollment process. Agents/brokers are tested on this annually.

Here are some Medicare rules that protect you. Be on guard for these Medicare marketing violations.

* You receive unsolicited telephone calls or people show up at your door to get you to join a Medicare Advantage or Prescription Drug Plan. An agent/broker can only contact you through direct mail or email, provided the email has an opt-out or unsubscribe feature. He or she cannot telephone you unless you have given permission in the form of a business reply card, Scope of Appointment form, or you have initiated contact by telephone, email, or other communication. If you’re a plan member, the plan, or your enrolling agent/broker may call you.

* Someone requests your Medicare, Social Security, or bank account number, or credit card information. Only provide information when you’ve initiated an application or request.

* You receive a call requesting payment by someone posing as an employee of your plan. Your plan must send you a bill unless you request a different form of payment.

* You receive a call where you end up enrolling into a plan over the phone, or online unless you provide consent to be enrolled into a plan. A person signed up over the phone and was stunned that her plan was changed, with her completely unaware.

* You are charged fees to process your enrollment or provide consultations about plans. You pay nothing for these services per Medicare regulations.

* You are offered cash, gifts, or meals contingent on enrolling in a plan, or while someone is trying to sell you a plan. A gift may be offered at a sales presentation if valued under $15, and the gift must be in a form that cannot be converted into cash.

Don’t ever sign an enrollment form unless you are ready to join a plan. Only sign when you’re ready to join. Your agent/broker must explain the plan’s Summary of Benefits and address your questions and concerns. The agent/broker will verify your provider’s network participation and check that your prescription drugs are on the plan’s formulary.

Don’t fall victim to these situations. If you encounter the incidents listed above, call 1-800-MEDICARE (1-800-633-4227), and promptly report it. TTY users should call 1-877-486-2048.

Leah Kari, AMR, FHIAS, specializes in showing Medicare beneficiaries their insurance options. Contact Leah at 520-484-3807 or email [email protected]. (TTY users dial 711.)