The Medicare open season, officially called the Annual Coordinated Election Period, is coming up. From Nov. 15 – Dec. 31 those eligible for Medicare can enroll, disenroll, and switch Medicare plans. Following that is the General Enrollment Period from Jan. 1 – March 31 when anyone eligible for Medicare can enroll.
Medicare fraud is around all year, but it increases at these times. Insurance companies increase their advertising and sales efforts, and the scam artists try to slide in among all the commotion and take advantage of a few seniors. This year we’ll have the additional complication of people making false claims about how health care reform affects Medicare.
The types of scams vary. Some crooks sell non-existent plans. They’ll have you sign a few papers, take a payment, and leave. Later you’ll find you don’t have any coverage. Or you may be enrolled in a plan you don’t really want, with limited coverage and limited choices of doctors and hospitals. Some cons say they’re enrolling you in a special type of Medicare plan. Then they enroll you in a standard health plan that isn’t part of Medicare and has minimal coverage.
It’s easy to be taken by a Medicare scam. The program is complicated, has its own language, and there are options for you to understand and choose from.
It’s also easy to avoid being taken. Remember a few simple rules and guidelines, and you’ll avoid scams. The rest of the year we give you tips for finding the best plans for you. This month we explain how you and those you care about can avoid the frauds.
No sales people are involved with traditional Medicare (Parts A and B). It’s a government-administered program that doesn’t pay sales commissions. You sign up for it by calling Medicare or going to its web site. No one will call you or knock on your door to encourage you to sign up, and you don’t have to make a deposit or write a check.
The rest of Medicare is provided through private insurers. These programs include Medicare Advantage (an alternative to traditional Part B), Part D Prescription Drug plans, and Supplemental Medicare (Medigap) plans. The private companies that provide these policies must be approved by Medicare and must follow specific marketing rules.
To avoid most Medicare scams it’s helpful to know the marketing rules, so you’ll be able to identify when someone is violating them. Legitimate, approved providers of Medicare services are not allowed to do any of the following:
? Cold calling. No sales person can call you for Medicare services or plans unless you contacted them first and requested a call. Approved firms must comply with the National Do-Not-Call Registry and requests not to call again. Callers can’t imply that they are calling on behalf of Medicare or that Medicare asked them to call.
? Unsolicited e-mails. A company can’t send you an e-mail unless you specifically requested information about a plan.
? Uninvited visits to your residence (including when you are in a nursing home). Again, you must ask the plan to send someone to visit you.
? Gifts worth more than $15, unless they are available to the general public. Gifts just for Medicare members or to induce you to join a plan are prohibited.
? Requesting personal or financial information over the phone. Don’t give information such as bank account numbers or your Social Security number over the phone. Keep that information confidential and put it on applications only when you are satisfied the plan is legitimate, know why the plan needs it, and are ready to apply. There’s no reason to give any personal information until you are ready to sign up for a plan.
? Marketing in areas where free meals are provided, at educational events, or in health care settings (except in common areas at a hotel or other facility).
? Cross selling. At the same appointment that you are purchasing a Medicare plan you can’t be sold life insurance or other non-health related products unless you requested information about them.
? Statements that a plan is Medicare Endorsed or a preferred Medicare provider. The word “Medicare” is allowed in the product’s name.
? Comparisons to another plan by name in advertising. You can find comparisons on the Medicare web site or by calling 800-MEDICARE.
There also are prohibited sales pitches and statements. These statements aren’t allowed but are common among the con artists. Here’s what a sales person isn’t allowed to say:
? You have to sign up for a particular private Medicare plan to receive Part D prescription drug coverage.
? You need to sign up for a particular plan to avoid losing your Medicare benefits.
? Not signing up for a particular plan will trigger higher Part B premiums.
? A visit to your home is required to provide information and take your application.
? Specific medical providers (such as doctors and hospitals) participate in the plan when they don’t. You should receive and review a current list of providers who are covered by the plan before signing up. Check to see that your preferred providers participate. Another good step is to call your doctor or other providers and ask if they participate in the plan. Or call a few names on the list provided by the salesman to ensure they participate.
? You always can return to Original Medicare or your prior plan. The sales person must point out that a return to Original Medicare is allowed only during the enrollment periods, and that if you’ve been in a private Medicare plan, such as a Medicare Advantage plan, you might not be able to return to that same plan. Of course, if the new plan is a fraud and not really a Medicare plan, it will be more difficult to re-enroll in Medicare because you will be considered to have disenrolled in Medicare.
Another way to avoid fraud is to check with Medicare’s web site or toll-free telephone number. Remember a plan must be reviewed and approved by Medicare. Information about all approved plans in your area is available on the web site or over the phone. When you can’t find information about a plan there, then it’s not a real Medicare plan.
Never let a sales person pressure you into making a fast decision. You should be able to study the plan documents, review it on the Medicare web site, call Medicare about it, and discuss it with family, friends, or advisors. Be sure all the promises made to you are in writing in the documents. Keep copies of everything, and keep notes of any telephone conversations, including the name of the person you talked to and the date.
RW September 2010.