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It's Medicare Open Enrollment Time - Beware of Scams

It's Medicare Open Enrollment Time - Beware of Scams and Unscrupulous Brokers

By Don Drake, Connelly Law Offices, Ltd.

Medicaid Planning Rhode Island
Attorney RJ Connelly III

"It's that time of the year again - the Medicare open enrollment for 2023 has started," said professional fiduciary and certified elder law Attorney RJ Connelly III. "It began on October 15 and runs through December 7, and allows plan enrollees to review their existing coverage and make changes or purchase new policies if they choose to do so. This period enables policyholders to reevaluate their insurance plans, including Original Medicare with supplemental drug coverage and Medicare Advantage plans (MA). During this time, individuals can compare different policies, check if their current coverage meets their healthcare needs, and make informed decisions about their future healthcare."

"Buckle up your seat belt and prepare to be bombarded by an endless stream of commercials from aging television and sports stars pushing Medicare Advantage Plans," said Attorney Connelly. "The problem is that much of what they promise is not available for most people, and they create confusion for those who are new to the Medicare system. And making a mistake can be costly."

The Real-Life Story of Tom Mills

In an article published by MedPage Today in 2021, the story of Tom Mills from San Diego is shared. Mills uncovered a disturbing truth about Medicaid Advantage plans that offer cheap rates and, in some cases, no premiums. Unfortunately, when someone falls ill, the out-of-pocket expenses skyrocket, and leaving the plan can be even more costly.

Medicaid Planning Massachusetts
Medicare Advantage plans can be confusing

Following his mitral valve repair and a mild stroke that did not result in any long-term complications, Mr. Mills from San Diego was confronted with a substantial increase in his monthly copays for prescription drugs and other medical services. Additionally, he was required to shell out $295 per night for each of his hospital stays.

Mr. Mills experienced a major surprise when he discovered that leaving his current MA plan would result in significantly higher expenses for any future medical interventions. Even if he switched to traditional Medicare with a prescription plan, he would still require a supplemental Medigap plan to cover his copays and deductibles, which amounted to 20% of the total cost.

The retired environmental geologist, despite being fit enough to train for marathons post-medical emergency, was facing a tough situation due to his pre-existing health condition. Seeking a Medigap plan was a daunting task for him as most plan providers either rejected him or demanded prohibitively higher premiums. His pre-existing condition, which included diabetes, heart disease, and a knee replacement, was enough to exclude him from most of the plans. A health insurance broker informed him that no supplemental plan would cover him and that applying for one would be a waste of his time. He had no prior knowledge of this side of Medicaid Advantage plans when he enrolled at the age of sixty-five.

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As a consumer, know all the facts

Attorney Connelly pointed out that celebrity endorsers like Joe Namath often highlight the benefits of Medicaid Advantage plans, such as free dental, vision, hearing care, gym memberships, rides to medical appointments, and access to doctors and nurses over the phone. However, they seldom mention the potential drawbacks of such plans, which can have serious consequences for low-income individuals in need of comprehensive medical coverage. Therefore, it's essential to have a thorough understanding of these plans before choosing one for coverage and to be wary of unscrupulous brokers. On the other hand, there are many more honest and hardworking brokers who genuinely care about their clients' best interests. Unfortunately, one or two bad experiences can tarnish the reputation of others in the industry.

Red Flags for Consumers

"As a consumer, it can be difficult to trust some insurance agents, especially when horror stories circulate about how they have scammed people into purchasing a Medicare plan that does not meet their needs," stated Attorney Connelly. "To prevent this from happening to you, I have listed eight red flags that could indicate a deceitful insurance broker or scammer at work."

1. Requesting your Medicare or Social Security number in advance.

Beware of brokers that request your Social Security number upfront. Providing sensitive information to unsolicited callers or texters can lead to identity theft or financial fraud. It is important to remember that legitimate insurers do not require your Social Security number to provide details about their plan coverage. If the person contacting you insists on obtaining this information, it is best to err on the side of caution and terminate the conversation immediately. You can simply hang up or block their number without feeling bad about it. Protecting your personal information is crucial in today's digital age, and by being vigilant and informed, you can avoid falling victim to fraudsters.

2. Insurance Booths.

If you find yourself waiting in line at the pharmacy, and suddenly, an insurance agent sitting at a booth tries to flag you down, be cautious. Booth Medicare agents usually have the goal to enroll as many people as possible in their Medicare plans. They know you are a prime target because you are likely to spend money on prescriptions and would love to save a few bucks. However, it's essential to keep in mind that if they don't have a permanent office location and are always setting up their booths, it may be challenging to get in touch with them when you need their services. Choose an insurance agent who is connected to a permanent office location and is always available to help you with your insurance needs.

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Callers may pressure consumers

3. Feeling Pressure from the Caller to Switch Plans.

As seniors approach retirement age, health insurance coverage becomes an essential need. Unfortunately, some unscrupulous representatives may take advantage of this need by using fear tactics to pressure seniors into enrolling in a plan. For example, they may falsely claim that a person risks losing coverage if they don't sign up right away. However, it's important to note that Medicare rules prohibit such statements. In fact, Medicare has strict guidelines in place to protect seniors from deceptive marketing practices. So, if you're a senior enrolling in a Medicare plan, it's crucial to be aware of your rights and to report any violations to the appropriate authorities.

4. The Agent Does Not Read the CMS Disclaimer.

As per new regulations issued by the Centers for Medicare & Medicaid Services (CMS), all Medicare insurance agents are required to inform their clients about the limited nature of their services before discussing potential Medicare plan options. Here is the exact statement that the insurance agent is required to make:

“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact or 1-800-MEDICARE to get information on all of your options.”

If the insurance agent you are working with fails to provide you with this information, they are not following CMS guidelines. This could suggest a lack of professionalism or even dishonesty. It is important to choose an insurance agent who follows CMS rules and is transparent about the carriers and plans they represent.

5. Offering a special discount for a "limited time".

Limited time offers that include special discounts can be perceived as a form of pressure to encourage seniors to sign up for a healthcare plan. These types of offers have been flagged for violating federal rules that prohibit companies or their representatives from offering any form of cash or free meals while trying to sell a plan. The aim of these regulations is to protect seniors from being taken advantage of by companies and to ensure that they make informed decisions about their healthcare plans based on their needs and not on any undue influence. Therefore, it is important for seniors to be aware of their rights and to carefully review any offers that are presented to them before making a decision.

6. Did the Agent Check Your Doctors and Prescriptions?

Keep in mind that physicians are not obligated to accept Medicare Advantage plans. Therefore, if you are considering enrolling in a Medicare Advantage plan, it is crucial to ensure that your doctors and other healthcare providers accept the plan before you make your final decision.

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The broker must review your medical providers

If you are working with a Medicare agent to choose the right plan for you, it is essential to ensure that they verify that your doctors and other healthcare providers accept the Medicare Advantage plan you are considering. If your agent fails to do so, you may want to seek assistance elsewhere.

If you enroll in a Medicare Advantage plan without verifying that your doctors accept it, you may find yourself in a difficult situation. For instance, you might schedule a visit with your physician, and they may order an EKG and request that you visit the lab downstairs for bloodwork. However, after the visit, you might receive a bill for the doctor's appointment and an invoice for the lab work, and you realize that your insurance plan did not cover any of it. This situation could occur because your agent did not check if your essential doctors and labs accepted the Medicare Advantage plan.

Additionally, it is essential to check if the plan covers your specific medications. If not, you might have to pay the total cost of your prescriptions if they are not listed on the plan’s formulary. Therefore, it is imperative to double-check that your essential healthcare providers accept your Medicare Advantage plan before enrolling to avoid any unpleasant surprises.

7. Someone from ‘Medicare’ promoting specific plans.

It has been observed that some plan representatives who claim to be calling from Medicare are misleading senior citizens. At the same time, there are scammers who openly identify themselves as being from Medicare. This puts the elderly in a vulnerable position, and the Federal Communications Commission (FCC) has taken a stern stance against such deceptive practices.

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"Scammers" may say they're from Medicare

The FCC has issued a warning, stating that the government’s Medicare program never contacts individuals unsolicited and requests personal or private information. It is critical to remember that Medicare representatives will never call and ask for your personal information over the phone. This includes your Social Security number, bank account information, or any other financial details.

It is essential to be vigilant when receiving such calls and to never share personal information over the phone unless you have initiated the call and are certain of the identity of the person on the other end. By following these guidelines, we can help prevent fraud and protect ourselves and our loved ones.

8. Unsolicited calls from plans or plan reps.

During the open enrollment period, it is common to receive unsolicited calls from Medicare plans. However, it is important to note that such calls are not in line with the regulations set forth by the government. According to the Centers for Medicare and Medicaid Services, Medicare only allows plans to contact you if you have given your permission or if you are already a plan member.

If you happen to receive a call or email from a Medicare plan without your consent or come across a company that engages in unethical practices, it is your right to report them to the Centers for Medicare and Medicaid Services. The CMS is the federal government agency responsible for overseeing Medicare and Medicaid programs and ensuring that they are in compliance with the rules and regulations set forth by the government. By reporting such practices, you can help prevent others from falling victim to these types of scams.

Reporting Fraud

If you come across any harmful or fraudulent activities regarding Medicare Advantage and drug plans, you have three ways to report them. You can either file a complaint online on the official Medicare website, call the Medicare hotline to report the issue, or mail a written complaint to your local Medicare office. These options ensure that you can report any bad practices related to Medicare Advantage and drug plans and keep yourself and others protected. Please see the below resources:

  1. Call Medicare at 1-800-MEDICARE (1-800-633-4227).

  2. Call the Investigations Medicare Drug Integrity Contractor (I-MEDIC) at 1-877-7SAFERX (1-877-772-3379)

  3. Send a letter to I-MEDIC at Qlarant, 28464 Marlboro Avenue, Easton, MD 21601, Attn: I-MEDIC

If you need to reach out to Medicare for assistance, it's important to be prepared with the necessary information. When contacting Medicare, you should be ready to provide your full name and Medicare number, along with any other details that can help identify you. Additionally, it's helpful to have the name of the company or organization in question, along with any specific information about the marketing or sales practices that you believe were questionable. This will help ensure that the Medicare representative you speak with can provide you with the most accurate and effective assistance possible.

A Final Word

"I can't emphasize enough the importance of truthfulness and accuracy in advertisements, as mandated by Federal law," stated Attorney Connelly. "After closely observing several commercials this weekend, I found that the information presented about the costs and benefits of Medicare plans was accurate, to the extent that it was mentioned. However, there were crucial details that were left unstated or understated, which are essential for making an informed decision. To avoid making a wrong choice or becoming a victim of fraud, it is important for consumers to be educated. In the next few blogs, we will discuss more about open enrollment and identify and discuss some very important information everyone needs to know about Medicare and open enrollment."

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Please note that the information provided in this blog is not intended and should not be construed as legal, financial, or medical advice. The content, materials, and information presented in this blog are solely for general informational purposes and may not be the most up-to-date information available regarding legal, financial, or medical matters. This blog may also contain links to other third-party websites that are included for the convenience of the reader or user. Please note that Connelly Law Offices, Ltd. does not necessarily recommend or endorse the contents of such third-party sites. If you have any particular legal matters, financial concerns, or medical issues, we strongly advise that you consult your attorney, professional fiduciary advisor, or medical provider for advice.

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