open enrollment

Medicare Open Enrollment Begins Oct 15 – What to Do & How to Protect Yourself from Enrollment Fraud

Medicare’s fall open enrollment (also known as the Annual Election Period) is just around the corner. Running from October 15 – December 7, this is the main time you can make a change in your Medicare coverage for the coming year, with changes effective January 1st.

If you’re in a Medicare Advantage and/or Part D prescription drug plan, each year your plan can change their premium, deductible, cost-sharing and some benefits, or discontinue their coverage altogether. It’s important to be aware of how your plan may change, and prepare accordingly. Your plan should have mailed you its Annual Notice of Change (ANoC) by September 30 with any upcoming changes in premiums and copayments, if your plan’s provider network will change, and/or a list of drugs (called a formulary) that will be covered.

Make sure to view these changes and review at your options for the coming year. If you’d like help or guidance in navigating all the changes and options, schedule an appointment with your local Health Insurance Counseling and Advocacy Program (HICAP). They offer free, unbiased, and one-on-one assistance in reviewing your Medicare coverage options for 2023. See our Open Enrollment page for more details on what do to and resources to help during Open Enrollment.

Tips to protect yourself from marketing violations and enrollment fraud

As of October 1, 2022, all Medicare Advantage and Part D plans and their insurance agents can also start marketing the 2023 plans and products. The onslaught of marketing materials, educational events and information can be confusing and overwhelming. One way you can protect yourself from deceptive marketing or enrollment fraud, is to know what insurance agents and brokers can and can’t do. The Center for Medicare and Medicaid Services (CMS) has strict marketing guidelines to protect beneficiaries from such manipulative and deceptive enrollment practices and fraud. Health plans, their sponsors, third party marketing agencies, agents and brokers are required to follow these guidelines and cannot market plans under the guise of “education.”

What plans and agents can do:

  • Call a beneficiary who has expressly given advanced permission
  • Offer nominal gifts valued at $15 or less (or $75 in total, per person, annually) to beneficiaries, provided the gift is given regardless of whether a beneficiary enrolls in the plan
  • Include information about rewards and incentives programs in their marketing materials
  • Provide refreshments and light snacks, but not meals, at marketing/sales events
  • Make unsolicited contact with potential enrollees using conventional mail and other print media (e.g., advertisements) and by email provided it contains an opt-out function
  • Conduct marketing/sales activities in common areas of health care settings (i.e., waiting rooms, common entryways, vestibules, cafeterias, or community, recreational, or conference rooms)

What plans and agents CANNOT do:

  • Conduct marketing or sales activities at an educational event
  • Require participants to provide contact information to attend an event
  • Sell door-to-door or leave information like leaflets, flyers, door hangers, etc. on someone’s car or at their residence (unless the beneficiary is a “no show” for a prescheduled appointment)
  • State that they are approved, endorsed, or authorized by Medicare; are calling on behalf of Medicare; or that Medicare asked them to call or see the beneficiary
  • Send unsolicited text messages, make unsolicited phone calls, or leave voicemail messages for potential enrollees
  • Approach beneficiaries in public common areas (i.e., parking lots, hallways, lobbies, or sidewalks)
  • Provide information that is inaccurate or misleading
  • Offer health screenings or other activities that may be perceived as, or used for, “cherry-picking”

If you come across any plans/agents engaged in potential enrollment fraud, deceptive marketing or marketing violations, report them to our California Senior Medicare Patrol (SMP) at 1-855-613-7080. We’ve got your back!

Also, view our novella that shares what Medicare health plans and their agents CANNOT do in their plan marketing and provides savvy tips on how to protect yourself from enrollment fraud. It’s available in English and Spanish. Spread the word.