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Insurance Plan Marketing: Protect Yourself From Fraud!

Updated August 2014

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What We Will Cover Today

• Medicare Open Enrollment

• The SMP Program

• Medicare’s Marketing Rules for Insurance Agents

• The SMP Message:

Protect, Detect, Report!

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Open Enrollment

• Part D open enrollment:– October 15–December 7 each year– Coverage begins January 1 the following year

• Medicare Advantage open enrollment:– October 15–December 7 each year– Coverage begins January 1 the following year

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Disenrollment from Medicare Advantage

• Medicare Advantage Disenrollment Period– IF you enroll in a Medicare Advantage plan

during open enrollment, you can choose to disenroll between January 1 – February 14

– Can only switch back to Original Medicare:– Cannot switch to different Medicare Advantage plan

– If you miss this disenrollment period, you must wait until Open Enrollment at the end of the year to change your plan

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The SMP Programwww.illinoissmp.org

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The SMP Program

• Senior Medicare Patrol

• National Program – SMP Programs in all 50 states, Washington,

D.C., Puerto Rico, Guam, Virgin Islands

• Goals of program: Educate consumers about health care fraud and abuse

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SMP Staff and Volunteers…• Give presentations to groups (like this one!)

• Share information and materials at health fairs or other events

• Help people with questions about billing mistakes or fraud issues

• Help report fraud to investigators

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Illinois SMP Program Partners

• Illinois Area Agencies on Aging

• Catholic Charities

• White Crane Wellness Center

• Coalition of Limited English Speaking Elderly

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Medicare and Insurance Plans

• Insurance agents may sell a variety of products, including health insurance, life insurance, or investments, such as annuities. The only insurance products that work with Medicare are:

– Medicare Supplement (Medigap) plans– Part D Prescription Drug plans– Medicare Advantage plans

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Medicare’s Marketing Rules

• Insurance agents that sell Medicare Supplement Plans, Part D Prescription Drug Plans, and Medicare Advantage Plans must abide by Medicare’s rules for the marketing and selling of these plans.

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Medicare’s Marketing Rules

• Insurance Agents MAY:– Provide plan information at a “marketing” event

– Market plans in common areas (cafeterias, conference rooms, etc.)

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Medicare’s Marketing Rules

• Insurance Agents MAY NOT:– Market or sell plans at an educational event

• This includes any event that is advertised as an “educational” event - health information fairs, conference expositions, state or community sponsored events

• Agents may share “educational” materials at these events – “educational” materials may NOT have any marketing or plan-specific information on them

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Medicare’s Marketing Rules

• Insurance Agents MAY NOT:– Market plans in health care settings (waiting

rooms, exam rooms, pharmacy counters, etc.)

– Approach you in a parking lot or hallway to try to sell you a plan

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Medicare’s Marketing Rules

• Insurance Agents MAY:– Provide light snacks and/or beverages

– Give out gifts worth less than $15 (but must provide gifts to anyone – not only in exchange for plan enrollment!)

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Medicare’s Marketing Rules

• Insurance Agents MAY NOT:– Provide or pay for meals

– Offer money or gifts worth more than $15

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Medicare’s Marketing Rules

• Insurance Agents MAY:– Contact the following people by phone:

• People currently enrolled in a plan with their company• People who have given the company “permission” to

contact them (Note: “permission may include signing up at an event or returning a postcard!)

• People formerly enrolled in their plan to conduct a disenrollment survey

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Medicare’s Marketing Rules

• Insurance Agents MAY:– Market plans through direct mail

– Visit people at their home with an appointment

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Medicare’s Marketing Rules

• Insurance Agents MAY NOT:– “Cold” Call, use door-to-door marketing, or

market plans using any other unsolicited contact– Enroll you in a plan without your permission– Lie to you to get you to enroll in a plan– Tell you that a plan is “free” – Sign you up for a plan over the phone unless

you call them

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Medicare’s Marketing Rules

• Insurance Agents MUST:– Make an appointment with you before visiting

you at your home – Create an agreement with you about which

type(s) of plans or products will be discussed at your appointment. This agreement must be either recorded on the phone or in writing, with your signature on the form.

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Medicare’s Marketing Rules

• Insurance Agents MAY NOT:– Market or sell non-health care related products

(annuities, investments) during an appointment to talk about health insurance

– Discuss any products other than what you agreed to discuss before the meeting (you can make a new appointment, at least 48 hours later, to discuss additional products if YOU request it.)

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Medicare’s Marketing Rules

• Insurance Agents MUST:– Be licensed by the state of Illinois to sell their

products– Receive specific training and pass a test before

selling plans

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• If you believe that an insurance agent has violated one of the Medicare rules discussed here, contact the Illinois SMP program at (800)699-9043.

Report Fraud!

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Thank you!

If you have questions, contact:

AgeOptions

(800)699-9043

This presentation was supported in part by a grant (No. 90MP0163 and 90SP0061) from the Administration on Aging (AoA), Administration for Community Living (ACL), U.S. Department of Health and Human Services (DHHS). Grantees carrying out projects under government

sponsorship are encouraged to express freely their findings and conclusions. Therefore, points of view or opinions do not necessarily

represent official AoA, ACL, or DHHS policy.