People can protect themselves from Medicare enrollment fraud

From Senior Medicare Patrol

Medicare’s annual election period is about here, and it’ll be important to understand it so people can protect themselves. Also known as Medicare open enrollment, this is the annual period during which people on can re-evaluate their prescription drug plan or Medicare Advantage coverages and make changes.

During open enrollment, a beneficiary can:

• Switch Medicare Advantage plans.

• Switch from Medicare Advantage to Original Medicare or from Original Medicare to Medicare Advantage.

• Join a Medicare Part D prescription drug plan, switch from one Part D plan to another or drop Medicare Part D coverage entirely.

Open enrollment does not apply to Medigap coverage, however.

The enrollment period runs from Oct. 15 to Dec. 7 each year, and changes made during that time are effective January 1.

Medicare users need to be cautious during open enrollment.

Watch out for people who:

• Ask for Medicare number, Social Security number, and or bank information just to provide information. Someone can use this personal information to enroll people in a plan without their permission. Plans cannot request this personal information at an educational event and cannot call people to ask for a payment over the phone — they must send a bill.

• Pressure people with time limits to enroll in their plan. People can use the entire Open Enrollment Period to make their decision. They will not receive extra benefits for signing up early for a plan.

• Say they represent Medicare. Plans are never allowed to suggest they represent or are preferred by Medicare or any other government agency.

• Offer people gifts to enroll in their plan. Gifts must be given to everyone regardless of their enrollment and cannot be worth more than $15.

• Threaten people with the loss of Medicare benefits unless they sign up for their plan.

Tips for avoiding potential enrollment fraud:

• Confirm what a plan agent says before making a final decision about a plan.

• Ask for everything in writing.

• People should call their doctors to make sure they are in-network for the plan they want to join.

• Never provide Medicare information to anyone but their trusted health care providers.

• People should contact their SHIP to make sure THEY understand a plan’s costs and benefits before enrolling.

Report potential enrollment fraud and marketing violations

People should contact their Senior Medicare Patrol if they feel a plan or agent has violated Medicare’s marketing rules or if they think they were enrolled in a plan without their permission.

Questions about your Medicare coverage? People should:

Contact their State Health Insurance Assistance Program for trustworthy and unbiased counseling about your Medicare options.

• Report potential enrollment fraud and marketing violations.

• Contact their Senior Medicare Patrol — SMP — if they feel a plan or agent has violated Medicare’s marketing rules or if you think you were enrolled in a plan without your permission.

Remember that:

Plans can

• Send mail

• Send emails as long as an opt-out option is in the email

• Call or text about any plan business if the recipient gave the plan permission

• Provide meals valued at $15 or less at events advertised as educational

• Provide refreshments or light snacks at sales events

• Raffle a prize worth up to $15 per event attendee but the prize cannot be tied to enrollment

• Provide gifts worth up to $15 to each attendee of an event but the gifts cannot be tied to enrollment

• Visit people to discuss plan options if they schedule an appointment and the preson have formally agreed on the topics to discuss before the appointment, called scope of appointment

Plans cannot

• Send materials that look like they are from an official government source

•  Make unsolicited contact through calls, visits or texts with prospective enrollees

• Send unsolicited text messages

• Display business cards, sign-up sheets, or application forms at educational events

•  Approach people as a potential enrollee in public areas, such as parking lots or malls

• Conduct sales events in a health care setting unless it is a cafeteria or other common area

• Change or add to the agreed-upon topics for your appointment, unless the person agrees to a change of scope and the agent documents it before going forward

Medicare has rules about how plans can contact you and market their services for Open Enrollment.

The Senior Medicare Patrol helps to educate Medicare beneficiaries about ways to prevent, detect, and combat Medicare fraud.

For more information about Medicare fraud, visit the Stop Medicare Fraud website at http://www.stopmedicarefraud.org .