How to protect against Medicare fraud, predatory sales

Medicare open enrollment season, which starts Monday, is a time that traditionally draws out scammers and predatory sales tactics.

Along with traditional Medicare, commercial insurance companies also sell privatized plans called Medicare Advantage.

Here’s what you should know about what insurance agents can do and what sales tactics the Ohio Department of Insurance says are not allowed.

MORE: This new law means many more Ohio officials are watching out for elder abuse

Agents can:

• Distribute information and forms in a retail setting or while participating at a health fair or promotional event.

• Travel to meet Medicare beneficiaries in their home, provided they have been invited.

• Provide consumers information about public assistance programs and help individuals apply for government subsidies.

Agents cannot:

• Engage in high-pressure sales tactics.

• Send unsolicited emails.

• Collect names, addresses and enrollment applications or conduct sales presentations at a health fair or promotional event.

• Sell products which are not health-related during a Medicare Advantage or prescription drug plan sales or marketing presentation.

• Provide meals at promotional and sales events.

• Sell products in health care settings (doctors offices, pharmacies, etc.).

• Make misrepresentations or omit information about a comparative Medicare product to induce a person to purchase or change their insurance.

• Solicit door-to-door.

MORE: Anthem returning to ACA exchange in Ohio in 2019

The Ohio Department of Insurance gives the following advice for protecting yourself:

• Be wary of people who claim they work for Medicare. Medicare representatives do not make house calls or solicit beneficiaries by telephone.

• If someone comes to your home without a scheduled appointment, do not let the individual in your home or provide him or her with personal information.

• Be leery of insurance agents who tell you your enrollment in a Medicare Advantage Plan will not affect your Medicare coverage. When you sign up for a Medicare Advantage Plan you will be removed from your traditional Medicare plan and may incur more expenses in terms of deductibles and co-payments.

• Do not be persuaded by an insurance agent who tries to scare you into believing your Medicare rates are going to increase if you do not switch plans immediately.

MORE: Hospital network to repay student debt for some nurses

• Contact your health care providers to verify they participate in the plan or accept the plan you’re considering.

If you believe you have been the victim of a deceptive sales practice, contact the Ohio Department of Insurance at 1-800-686-1527.

Need help picking a plan? The Ohio Senior Health Insurance Information Program of the Ohio Department of Insurance provides free information and services to Medicare beneficiaries and the people who care for them at 1-800-686-1578.

About the Author