Each year Medicare updates its Medicare Marketing Guidelines to clarify what agents and plan sponsors can and cannot do as they marketMedicare Advantage and Part D plans to beneficiaries. While many of the guidelines have remained the same over the years, an important and controversial change was made for the current marketing of 2015 plans. In the past, agent and plan sponsors were only able to call members to discuss “plan business”, meaning the member’s current plan. They could not call to discuss other plan options. In September 2014, however, Medicare expanded the scope of “plan business” to include both a member’s current plan and other Medicare plan products.
While insurance agents, plan sponsors and third party entities are generally prohibited from making unsolicited calls, there a few exceptions. One exception is agents and plan sponsors are allowed to call their current clients and members, respectively. For example, if you have a Medicare Part D plan from Company A, Company A may call you to talk about its Medicare Advantage plan. Another example, if you have a Medigap plan, your insurance agent may call you to talk about other Medicare plan products.
Below is a list of the health plan marketing do’s and don’ts as summarized on Medicare.gov. If you or someone you know has any suspicion about questionable marketing behavior or tactics, please let us know by contacting our California Senior Medicare Patrol at 1-855-613-7080.
People representing Medicare plans aren’t allowed to:
- Ask for your personal information (like your Social Security, bank account, or credit card numbers) over the phone.
Note: If you applied for Extra Help paying for Medicare prescription drug coverage, someone from the plan, or an entity contracted by the plan, may contact you if any information is missing from your application.
- Come to your home uninvited to sell or endorse any Medicare-related product.
- Call you unless you’re already a member of the plan. If you’re a member, the plan or the agent who helped you join can call you.
- Require you to speak to a sales agent to get information about the plan.
- Offer you cash (or gifts worth more than $15) to join their plan or give you free meals during a sales pitch for a Medicare health or drug plan.
- Enroll you into a plan, in general, over the phone unless you called them and asked to enroll.
- Ask you for payment over the phone or web. The plan must send you a bill.
- Sell you a non-health related product, like an annuity or life insurance policy, during a sales pitch for a Medicare health or drug plan.
- Try to sell you products other than the ones you indicated when you made your appointment with the agent. The agent must document either in writing or through a recorded phone discussion the products you agreed to discuss during your meeting.
There are certain settings where marketing is not allowed at all:
- Areas where you get health care like an exam room, hospital patient room, or at a pharmacy counter.
- Educational events like a health fair or conference.
Note: independent agents and brokers selling plans must be licensed by the state of California, and the plan must tell California which agents are selling their plans.
Rules an agent must follow when having a meeting with you
If you’re going to meet with an agent, the agent must follow all the rules for Medicare plans and some specific rules for meeting with you.
During the meeting, Medicare plans and their agents can:
- Give you plan materials.
- Tell you how to get more plan information.
- Tell you about the plan options you agreed to discuss.
- Give you an enrollment form.
- Collect your completed enrollment form.
- Leave business cards for you to give to friends and family.
During the meeting, Medicare plans and their agents can’t:
- Charge you a fee to process your enrollment into a plan.
- Steer you into a particular plan.
- Communicate incorrect information about their plan type or use inappropriate statements like their plan is “the best” or “highest ranked.”
- Pressure you to join their plan by saying things like “you have to join this plan or you won’t have coverage next year.” Or “you have to join this plan or you won’t be able to see your doctor anymore.”
- Ask you to give names and phone numbers or addresses of your friends or family as marketing leads.
- Ask you to sign the enrollment form before you’re ready to join.
- Make sure you only sign an enrollment form when you’re ready to join.
After the meeting:
- The plan is required to contact you to make sure you want to join and that you understand how the plan works.
Extra rules for agents selling Medicare Private-Fee-For-Service (PFFS) Plans
Agents selling Medicare PFFS Plans must:
- Give you written information with a complete description of how the plan works.
- Make clear that there’s no guarantee that your doctor or hospital will agree to accept. the plan’s terms and conditions or provide you with treatment if you join the plan.
- Send you a letter if they can’t reach you by phone with instructions on how to disenroll if you change your mind.
- Have people available to answer any questions from you, your doctor, or other providers about the plan.
How to report a plan that doesn’t follow the rules
- Call our Senior Medicare Patrol at 1-855-613-7080.
- Call 1-800-MEDICARE.
- Call the Medicare Drug Integrity Contractor (MEDIC) at 1-877-7SAFERX (1-877-772-3379).
See Medicare Fraud for more information.
