Bad Actors — Is That Call a Medicare Scam?

by | Sep 12, 2022

Unfortunately, bad actors use tactics to mislead and confuse Medicare eligibles about their health insurance. This opens the door to buy subpar coverage. The plain truth is that Medicare, the process, and often, features of the Medicare Advantage Plans, can be complex. Downright confusing. We all know someone that has been a victim of one of these issues. While we are on guard more than ever, how do we identify bad actions? Countless numbers of my new and long-term clients have received these calls, and it’s left me quite concerned.

The Centers for Medicare and Medicaid Services (CMS) is the authority on all things Medicare — the process of getting Medicare, the various enrollment periods, the penalty amounts and phases, marketing activity requirements from an insurance carrier and insurance agents. CMS’ marketing requirements are specific. Yet even reputable firms violate them. It is in this nature that I wish to educate you, and perhaps arm you with information to respond to these calls and scams.

Marketing Requirements — Medicare Advantage and Prescription Drug Plans

  • • People representing Medicare plans are not allowed to come to your home uninvited to sell or endorse anything.
  • • Insurance agents are not allowed to make cold calls without your express, written or verbal permission. An example of acceptable permission would be when you provide your contact information in response to a Facebook or other advertisement.
  • • Agents cannot send unsolicited text messages or leave voicemail messages.
  • • Beware of cold calls encouraging you to switch plans.
  • • The agent who helped you join your plan can call you.
  • • When you initiate a call to a Medicare agent, they can make an appointment but must advise you of the Scope of Appointment (form you sign or record verbally) to advise you of the type of product you will discuss, and that you have no obligation to enroll.
  • • Insurance carriers may call their members and offer a basic review/visit from a member of the medical community. These are conducted from the comfort of your home, often referred to as House Calls.
  • • A customer service representative from 800-MEDICARE can call you if you initiated the call and left them a message.
  • • Starting October 1, 2022, all sales calls must be recorded. CMS specifically mentioned the call centers that use commercial ads in this new ruling.

Here’s how hard it is to fix when you have been enrolled in a plan that’s not right for you. You will need to qualify for a Special Election or wait for Annual Enrollment in October to rectify the unwanted change. This could cost you the ability to see your doctors or prescriptions until a new plan can be put in place.

Don’t let an unannounced visitor or impersonal cold-caller try to build your Medicare plan for 2023. Consult an expert, someone that holds credentials in Medicare, knows your community, researches your doctors and prescriptions at a minimum. Then continues to work to find your additional needs like hearing aids, transportation, vision, and dental before recommending a health plan.

Let me explain. Realizing you will pay to obtain the primary benefit of Medicare is only the beginning. Overall, there are two separate costs—the cost of getting Original Medicare and the price of a supplement and prescription coverage. High-income earning individuals will also pay an Income Related Monthly Adjustment Amount (IRMAA).

About Dayna Schafer

Dayna is a Certified Medicare Insurance Planner®, a member of the National Association of Health Underwriters (NAHU), and a member of the Rise Community. Her agency, located in St. Petersburg and Homosassa, FL where she has helped thousands of individuals and Medicare beneficiaries understand their benefits. Dayna understands the many phases of insurance purchases her clients go through. She feels the complexity in the needs of everyone she works with, and the need for quality, reliable guidance. To relentlessly seek out the right fit for her client’s healthcare needs, Dayna certifies with 10 insurers.

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