Transcript California Health Advocates Presents: Medicare and Disability

Take Control
Be Informed
What Every Medicare Beneficiary
needs to know to survive Annual
Enrollment
October 2009
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 doorto 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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Protections cont.
• Approaching in common areas
i.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
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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-Branding
42 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
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