Medicare Fraud Spotlight

Marketing Rules for Medicare Advantage Plans

As we get closer to the 2023 Open Enrollment Period, the number of TV, radio and print ads for Medicare Advantage Plans will be on the rise – as will the number of calls and pitches from insurance agents. There are specific marketing guidelines that Medicare Advantage plans and agents selling these plans must follow. These guidelines are set by Medicare, and knowing what IS and IS NOT allowed can help you avoid becoming a victim of Medicare fraud.

Individuals selling Medicare Advantage are not allowed to do any of the following:

• Ask for your personal information over the phone unless it is needed to verify membership, determine enrolment eligibility, or process an enrollment request (i.e. Medicare, Social Security number, bank account, or credit card number).
• Show up at your home uninvited.
• Call you unless you are already a member of the plan.
• Ask you for payment over the phone or online. The plan must send you a bill.
• Sell you a non-health related product, like an annuity or life insurance policy, during a sales pitch for a Medicare Advantage plan or drug plan.
• Communicate incorrect information about their plan or tell you about other plan options you had not agreed to discuss
• Offer you cash (or gifts worth more than $15) to join their plan or give you free meals during a sales pitch.
• Talk to you about their plan in areas where you get health care like an exam room, hospital patient room, or at a pharmacy counter
• Market plans or enroll you drug an educational event like a health fair or conference

Recently, Iowa SHIIP-SMP heard from a beneficiary who had dialed a phone number from a TV commercial he saw advertising Medicare Advantage plans. When he dialed the phone number, a representative asked him for his Medicare number and asked him where he lives. The representative convinced the beneficiary to enroll in an MA plan, despite knowing that the plan was not available to beneficiaries in his county. The following week, the beneficiary discovered that his prescriptions were not covered by his new policy, and he was required to pay out-of-pocket.

Thankfully, he called SHIIP/SMP and we were able to help him file a complaint, and get him reinstated into his former Medicare plan.

Be wary of anyone who uses tactics described above to sell you a Medicare Advantage plan. When in doubt, or if you are concerned you may have experienced a case of Medicare marketing fraud, contact SHIIP-SMP to get answers and support. You can reach SHIIP-SMP between 8am-4pm on Monday through Friday at: 1-800-351-4664 or via email at shiip@iid.iowa.gov