• Skip to main content
  • Skip to secondary menu
  • Skip to primary sidebar
  • Skip to footer
California Health Advocates

California Health Advocates

  • Contact
  • Home
  • About Us
    • Contact
    • Our Team
    • Mission
    • Education Services
    • About HICAP
    • Press
    • Testimonials
  • MEDICARE COUNSELING
  • Fact Sheets
  • Topics
    • The Basics
    • Prescription Drugs
    • Low-Income Help
    • Medigap
    • Medicare Advantage
    • Other Health Insurance
    • Appeals
    • Billing & Claims
    • Disabilities
    • Long-Term Care
    • Tribal Nations & Medicare
    • Health Care Reform
    • Advocacy & Policy
    • Glossary
  • Fraud & Abuse
  • Medicare Complaints
  • Blog
  • Donate

Be Aware of Agent Misconduct ~ Know Medicare’s Marketing Rules

California Health Advocates > Fraud & Abuse > Be Aware of Agent Misconduct ~ Know Medicare’s Marketing Rules

Posted by Karen Joy Fletcher on August 8, 2018

With Medicare’s fall open enrollment period just a couple months away (Oct 15 – Dec 7), it’s good to remind ourselves of Medicare’s marketing rules. Knowing the “do’s and don’ts” that all insurance agents and brokers must follow, helps to detect and prevent fraud. Here are some simple reminders…

CMS Marketing Rules Do Not Allow:

  • Unsolicited phone calls or home visits (Note: in the updated Medicare Communications & Marketing Guidelines, agents CAN now send unsolicited emails as long as there is an opt out function in the email)
  • Offering prizes or cash to enroll
  • Enrolling a beneficiary in a Medicare Advantage or Supplement plan over the phone, unless the beneficiary initiated the call to enroll

Beware of:

  • Agents warning “you must change plans every year”
  • Limited offers, early bird discounts
  • Agents gaining access to housing complexes
  • Agents collecting Medicare numbers

A recent example of agent misconduct came through our California Senior Medicare Patrol (SMP). It was a case in the Fresno/Madera area involving a husband and wife. The wife had gone to see her doctor, and upon leaving the office, the receptionist gave her a card for an insurance agent. The wife, trusting the recommendation from her doctor’s office, called the agent who then came to her home and swiftly signed her up for a Medicare Advantage plan. After realizing what just happened, the wife called the agent back to dis-enroll. The agent was repeatedly unavailable, so she was referred to another representative/agent.

When the second agent attempted to follow up with the wife, the husband answered the phone, and…was also swiftly enrolled into the same plan as his wife. Infuriated, the couple turned to their local Health Insurance Counseling and Advocacy Program (HICAP) to get assistance to disenroll from this Medicare Advantage plan and return to Original Medicare. Our Senior Medicare Patrol (SMP) has forwarded this case on to the Department of Managed Health Care for investigation.

For more information on what agents can and cannot do, review Medicare.gov’s Rules for Medicare health plans and the newly updated Medicare Communications & Marketing Guidelines.

If you come across any agent misconduct, please report it to our California SMP at 1-855-613-7080.

Filed Under: Fraud & Abuse, Medicare Advantage, Professionals

Previous Post: « Special Election Period Changes for Dual Eligibles & Others with Extra Help, Starting in January 2019
Next Post: CalABLE Will Allow Qualified People with Disabilities to Save Money without Fear of Losing Public Benefits »

About Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA's Communications Director. With a Masters in Public Health from UC Berkeley, she is the online "public face" of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a "communicator" and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.

Related Posts

  • Got Medicare Coverage Problems? Let’s Troubleshoot
  • Getting People the Right Medicare Coverage
  • Help Us Assist People in Getting the Right Medicare Coverage for Them
  • CMS’ Medicare Provider Directories Have High Levels of Inaccuracies

Primary Sidebar

Change Text Size

  • 100%  110%  120%  130%  

News & Blog Categories

  • Medicare Advantage
  • Low-Income help
  • Medicare & Disabilities
  • Medicare Basics
  • Prescription Drugs
  • Medicare & Other Health Insurance
  • Medicare Billings, Claims & Appeals
  • Health Care Disparities
  • Fraud & Abuse

—

  • COVID-19
  • Resources
  • Health Care Reform
  • Long-Term Care
  • CHA News

—

  • Advocacy & Policy
  • Letters and Comments to Policymakers
  • Legislative and Congressional Testimony
  • Policy Briefs

Send Us Comment

Do you have comments or concerns about your Medicare coverage? Issues regarding getting your needed prescriptions from your Part D plan, or a Medicare Advantage plan representative's marketing practices? Let us know at comments@cahealthadvocates.org.

We are dedicated to making Medicare's program work well for all beneficiaries. Your feedback from your own or your client's concerns and experiences with Medicare, will guide our Medicare advocacy efforts with key policy and decision-makers in both California and nationally with the Centers for Medicare and Medicaid Services (CMS) and Congress.

Archives

Donate Today

Footer

Sign up for our newsletter

Choose the news you'd like to receive

Important Links

  • About Us
  • Fact Sheets
  • Blog
  • Donate
  • Contact
  • Privacy Notice
  • Cookie Policy
  • Accessibility Statement

Follow Us

Copyright © 2023 · California Health Advocates · Web Design by TWK Web and Print Design · Log in