Insurance Companies & Agents Have Guidelines

The Centers for Medicare & Medicaid Services (CMS) have established rules, regulations and guidelines that insurance companies, agents and brokers must follow when selling Medicare Advantage plans, Part D plans, cost plans, employer/union-sponsored group Advantage and Part D plans, and special needs plans. These rules and regulations are meant to prevent plans and agents from presenting misleading information and utilizing high pressure sales tactics. They also contain rules for how plan representatives may contact and market to beneficiaries.

With the upcoming Open Enrollment period, October 15—December 7, violations of these rules and regulations have been detected throughout the state.

Examples of Violations

• Marketing plans prior to October 1
• An insurance agent implying they are associated with Medicare
• Soliciting potential enrollees door-to-door
• Sending unsolicited text messages or voicemail messages
• Marketing or conducting sales activities in apartment and residen-tial settings outside of the recreational or conference rooms
• Promoting one aspect of the overall plan, such as just the drug plan
• Asking for credit card, banking information, your Medicare or Social Security number to receive information
• Using high pressure sales tactics and/or incorrect information:
  • Threatening that your Medicare may end if you don’t enroll
  • Saying you must enroll by a certain date

Violations Witnessed and Reported

• “If you don’t sign up now, you will be dropped from Medicare” —this is FALSE, you won’t be dropped from Medicare
• Knocking on doors at residential living settings —this practice is not allowed
• Trying to sell you a life insurance policy or an annuity at the same time you are discussing Medicare plans—not allowed

What Should I Do?

If you have witnessed any of these violations, or encounter any in the future, please do the following:

• Get the name of the company and agent
• The address of the company
• Collect any materials available
• Note the location and date
• Document any information related to the violation
• Contact the SMP at the information provided

What can ADRCs, senior centers, independent living centers, and others do to help?

• Familiarize yourself with the Medicare marketing regulations (An informational sheet follows this Alert)
• Spread the word about Medicare marketing regulations. Distribute SMP flyers and Fraud Alerts
• Screen any companies or people who want to give information or present to older adults on any health insurance topic
• Monitor behavior when agents are present
• Establish a policy to not allow representatives to collect personal information or Medicare numbers from attendees
• Establish a policy to not allow an agent, or visitor, to meet with any resident without verifying they have a previously arranged appointment
• Request Wisconsin Senior Medicare Patrol staff give a presentation to your group to educate beneficiaries on Medicare fraud