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

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

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.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.