Medicare Open Enrollment: Tips to Protect Yourself and Get the Coverage that Serves You
Every year during Medicare’s Annual Enrollment Period (AEP) from October 15th to December 7th, millions of beneficiaries have the opportunity to switch or drop their current plan and enroll in a new plan that better suits their health care needs. When originally signing up for Medicare, an enrollee has two options; 1) sign up for Part A hospitalization, Part B outpatient care & preventive services, Part D prescription drug coverage, and a medigap/supplemental or 2) a private insurance Medicare Advantage plan known as Part C. It is important that those who sign up for original/traditional Medicare or choose to opt-out and go the private insurance Medicare Advantage route, understand the important difference between these two options.
Medicare is complicated and many of our elderly may not know what plan they’re actually on. During the annual enrollment period that began October 15th, this confusion is heighted by the postcards, letters, emails, and texts that everyone begins receiving, starting in late August. Somewhere on the mailing or text you will see in bold lettering the word MEDICARE or MEDICARE NOTICE. Do not be deceived, these forms of contact are not from original/traditional Medicare, the federal agency that sent you a red, white, and blue card when you originally enrolled. If you respond to any of these mailings, texts or calls, there will be an insurance agent or broker who would like to enroll you in one of their private insurance plans. Last year alone, Medicare received complaints that more than 39,000 beneficiaries had been improperly switched into plans that excluded their preferred Doctors, did not offer the coverage promised, or caused higher out-of-pocket expenses when co-payments and deductibles were not properly factored in.
Senior Medicare Patrol (SMP) is a national federal program that empowers and assists Medicare beneficiaries and their families to prevent, detect, and report Medicare fraud errors and abuse. SMP relies on teams of volunteers who are the “eyes and ears” in their community and assist with SMP counseling, outreach and education. It is during Medicare’s AEP when SMP receives heightened complaints and reports of fraudsters and scammers seeking to steal medical identities and confuse seniors into giving out private confidential information. And some of these types of contacts may be from unscrupulous insurance brokers and agents who switch beneficiaries into plans that are inappropriate for their individual health care needs. Senior Medicare Patrol receives and reports these types of complaints. As of October 1st 2022, private Medicare Advantage Plans and insurance agents and brokers must state upon initial telecommunication contact that“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 Medicare.gov or 1-800-MEDICARE to get information on all your options.” The problem has been that many o f those enticing ads with popular celebrities are national advertising campaigns may not be offered in Connecticut. And now, as of October 1st, if a beneficiary is enrolled as a result of such contact, the enrollment must be recorded in its entirety and kept for 10 years. This is a great help for Senior Medicare Patrol, as the recording can be requested to ensure that a fully informed decision was made by Medicare beneficiaries if they decide to switch into a different plan.
In a memo released October 19th, 2022, Medicare cautioned all Medicare Advantage Organizations that as a result of recent “secret shopping” calls with the numbers associated with television ads, mailings, and newspaper advertisements, it was discovered that some agents were not complying with current regulation and unduly pressuring beneficiaries, as well as failing to provide accurate or enough information to assist beneficiaries in making informed health care decisions. Medicare is closely monitoring marketing activities during the 2023 (when your new enrollment begins) open enrollment. This includes marketing that is misleading, confusing, or misrepresents a benefit or product, and will take compliance action against plans for activities and materials that do not comply with Medicare’s requirements. If you or a family member or caregiver suspect that either of the above circumstances apply to you, please call and report your case to Senior Medicare Patrol at 1-800-994-9422.
Submitted by: Audrey Cole, Senior Medicare Patrol, Coordinate of Volunteers at the Western CT Area Agency on Aging
Federal Register /Vol. 87, No. 89 /Monday, May 9, 2022 /Rules and Regulations 27819 F. Marketing and Communications Requirements on MA and Part D Plans To Assist Their Enrollees (§§ 422.2260 and 423.2260, 422.2267, and 423.2267)
Paid for in part by grant number 90MPPG0044, from the U.S. Administration for Community Living, Department of Health and Human Services and is administered by the CT Department of Aging and Disability Services