Tips to Avoid Insurance Marketing Scams

Medicare beneficiaries have many choices to make about their Medicare coverage. While most insurance agents are honest, some dishonest agents may take advantage of the large number of choices and enroll people into plans that are not good for them. Medicare has marketing rules to prevent this. If an agent breaks one or  more of these  marketing rules, it should be reported. Here are some of Medicare's rules to prevent dishonest  insurance sales:

Insurance Agents selling Medicare Part D, Medicare Supplement, or  Medicare Advantage plans may NOT:  

• Enroll you  in a plan without your permission.
   
• Lie to you to get  you to enroll in a plan, or tell  you that a plan is "free."
  
  
•  Sign you  up for a plan over the phone unless  you call them.
   
• "Cold" call, use door-to-door marketing, or  market plans using any other form of unsolicited contact. Insurance agents may contact  you about your current plan if you are enrolled  in a plan with their company; they may contact you for a disenrollment  survey if you leave the plan; and they may contact  you if you have given them permission to contact  you. (Note: signing up for information at an event or returning a postcard counts as "permission.")  With your permission, an agent may schedule a time to meet with you in your home, but s/he may not come unannounced.
   
• Market or sell insurance plans at an "educational" event. If a community event is labeled as "educational," an insurance agent is not allowed to sell plans at that event. 
• Provide or pay for  meals. Insurance agents are allowed to provide drinks and small snacks while marketing their plans, but they are NOT allowed to provide enough food to be a meal or  pay for a meal, such as at a restaurant.
   
• Market plans in health care settings. Insurance agents may not sell plans in waiting rooms or exam rooms, at pharmacy counters,  or in other  health care settings. They also may not approach  people in  parking lots or hallways to try to sell plans. They may set up tables in common areas, such as a cafeteria or conference room.
   
• Offer gifts worth more than $15. Insurance agents are allowed to use small gifts, worth  less than $15, to market their  plans. However, they must offer those gifts to anyone who is interested. Gifts may NOT  be given as a reward for enrollment  in a plan.

The Illinois SMP (Senior Medicare Patrol) Program educates consumers about health care fraud, waste, and abuse. If you have questions about a claim on your Medicare Summary Notice or Explanation of Benefits, call the Illinois SMP program at (800)699-9043. Information about the Illinois SMP program is also available on our website: www.illinoissmp.org.

This document was supported, in part, by grant number 90MP0026 of the U.S. Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent officia1dministration
on Aging policy.