take control be informed what every medicare beneficiary needs to know to survive annual enrollment...

Take ControlBe Informed

What Every Medicare Beneficiary needs to know to survive Annual

Enrollment

October 2009

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Knowledge is Power

• Understanding Medicare Benefits puts you in control of your Health Care.

• If you are satisfied with your current Medicare coverage option, simply review your plan carefully for any new changes.

• If you decide you want to explore more options know your rights.

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Medicare has tightened regulations pertaining to the sale of

Medicare products

• Historically, Sale Abuses have been prevalent.

• Know what sales agents can and cannot do.

• If you suspect Medicare Abuse or Fraud, Report it.

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You are protected from Unsolicted Contacts

42 CFR 422.2268(d) and 422.2268(d)-CMS 4141-F

– The rules extend existing prohibition on door-to door solicitation

No– Outbound marketing calls, unless beneficiary

requested the call– Calls to former members to market plans or

products– Calls to confirm receipt of mailed information

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• Approaching in common areasi.e. Parking lots, hallways, lobbies, etc.

• Calls/visits after attendance at sales event, unless express permission given

• Unsolicited e-mails

• Gifts cannot be given unless they are nominal and less than $15.00 in value

Protections cont.

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Plans are allowed to ….

Calls are permitted to:• Existing members to conduct normal business related to plan• Former members for disenrollment survey

• Only after disenrollment effective date• May not include sales or marketing information

• LIS-eligible members being reassigned• Limited circumstances subject to advance approval

• Members by the agent/broker who enrolled them in the plan• Beneficiaries who have given express permission

• Applies only to entity from whom beneficiary requested contact for duration of that transaction, or as indicated by the beneficiary

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Beware of “Cross-Selling”

42 CFR 422.2268(f) and 423.2268(f)-CMS 4131

• Providers cannot use the MA plan sales as an entry to sell you other non-health related products– Examples: annuities, life insurance

• If the beneficiary requests this information then it maybe provided

• Products to be discussed must be agreed upon completing a scope of appointment form.– Examples: Medigap, MA or PDP

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Where can plans market?• No Plan Marketing Activities in

Healthcare settings– No sales activities or

distribution/acceptance of enrollment forms– Examples: waiting rooms, exam rooms,

hospital patient rooms, dialysis centers, pharmacy counter areas.

• Marketing is allowed– In common areas such as: hospital or

nursing facility cafeterias, community or recreational rooms, conference rooms

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Can plans market at Educational Events?

• No plan marketing activities at educational events– Event advertising materials must include

disclaimer– No sales activities, or distribution/acceptance of

enrollment forms and/or business reply cards• Examples: health information fairs, conference

expositions, state or community sponsored events

• Plans may distribute– Medicare and/or health educational materials– Agent/Broker business cards upon beneficiary

request but cannot contain marketing information

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Co-Branding42 CFR 422.2268 (n) and 423.2268(n)- CMS 4138-IFC

• Co-branding means that plans are not permitted to put names and logos of network partners on materials such as ID cards.– Example-No Pharmacy brand on ID card– If on other marketing materials there must be a

disclaimer stating that other pharmacies are available

• Exceptions– Plans that have a network exclusive to that

provider

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NO FREE LUNCHES/MEALS

• Prospective enrollees may not– Be provided meals or have

meals subsidized

• Applies at any event or meeting where– Plan benefits are being discussed or

materials are being distributed– Agents/Brokers may provide

Beverages or light snacks such as fruit, raw vegetables, pastries, cookies, crackers, muffins, cheese chips, etc.

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Know with whom you are dealing

• If MA and PDP plans use agents/brokers they must by state-licensed

• If a plan terminates an agent/broker they must report this to the state in which they are appointed and the reason for termination

• Agent/Broker Compensation has been greatly modified to eliminate inappropriate moves

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Protect yourself and Medicare

• Treat your Medicare Card like any other Credit Card, protect your identity and privacy.

• If it sounds too good to be true, it probably is, ask questions, get assistance before you make a decision.

• Beware of “Free services” Nothing is Free in Medicare, someone pays!

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Resources• Consumers should take their time and

not make hasty decisions.• HICAP 1-800-434-0222

- www.cahealthadvocates.org • TIPS line 1-800-447-8477• Social Security Administration

1-800-772-1213• 1-800-MEDICARE (1-800-633-4227)

- www.medicare.gov