Review the Rules:
Don’t Get Caught in Medicare Health Plan Marketing Scams


Introduction

 

Marketing scams for Medicare prescription drug plans (PDPs) and Medicare Advantage plans (MAs), including MA plans with prescription drug coverage (MA-PDs), are not new to the 2006 annual enrollment period. For over a year advocates have complained about such scams as going door-to-door at senior housing facilities to solicit enrollment in MA plans, enrolling beneficiaries in a more costly PDP than the one they wanted to enroll in, or enrolling beneficiaries in an MA-PD when they wanted to enroll in a PDP. The most recent scam involves Part D sponsors telling beneficiaries across the country that they must have a home visit to enroll in one of their PDPs. The agents who make the home visit then engage in a hard sell to enroll the beneficiary in one of the sponsor’s Medicare Advantage plans rather than in the PDP the beneficiary wanted.

 

The Centers for Medicare & Medicaid Services (CMS) has developed Marketing Guidelines for Medicare Advantage and prescription drug plans[1] that address the appropriateness of different sales tactics.  The CMS Enrollment Guidance[2] also provides instructions on permissible enrollment mechanisms. By understanding the scope of health plan activities, advocates can help protect the right of beneficiaries to choose how they will receive all of their Medicare health benefits, including their prescription drug coverage.

 

CMS Guidelines allow PDP and MA plan sponsors to:

CMS Guidelines do NOT allow plan sponsors to

Advocates who encounter marketing and enrollment problems should

Beneficiaries who enroll in a plan they do not want because of marketing scams or misinformation may be entitled to a special enrollment period (SEP) to change to the plan of their choice.  These SEPS are awarded by CMS on a case by case basis.  Advocates should therefore contact the CMS regional office to apply for this SEP.

 

 



 

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