Texas Department of Insurance
Consumer Protection – Mail Code 111-1A
CONSUMER ALERT
333 Guadalupe
P. O. Box 149091
Austin, Texas 78714-9091
1-800-252-3439 telephone
512-305-7463 fax
Consumer Tips for the 2010 Medicare Enrollment Period
The annual enrollment period for Medicare Advantage health insurance plans
and Medicare Part D prescription drug plans begins November 15 and ends
December 31, 2010.
Private companies that contract with the federal Centers for Medicare and
Medicaid Services (CMS) offer Medicare Advantage and Medicare Part D drug
plans. The plans change each year, and it’s up to each beneficiary to choose
whether to change to a new plan or keep their current plan for the upcoming
year.
CMS adopted rules to guide sales practices and to protect consumers from
improper marketing activities. The rules apply to all Medicare plans,
agents, and any contractors who work for these plans. Plans and agents:
* Must be licensed by the state.
* May not make unsolicited contacts, including door-to-door sales, cold
calls or approaching you in a parking lot.
* Must have an appointment in advance before coming to your home.
* Must arrange with you in advance the type of products that will be
discussed during a scheduled sales appointment. They may not attempt to sell
you other types of insurance coverage other than the type agreed upon in
advance.
* May not try to sell you non-health care related products (like a life
insurance policy or an annuity) during a sales or marketing presentation of
a Medicare plan.
* May not attempt to sell you a plan in a doctor’s office or in a pharmacy.
* May not attempt to sell you a plan at an educational event.
* May not offer you free meals at promotional or sales events.
* May not offer you gifts or other promotional items with a value greater
than $15.
Remember: While these plans may be a good deal for some people, they’re not
right for everyone. TDI cautions consumers to consider carefully before
making any changes to their Medicare coverage. You should have received a
notice from your Medicare Advantage or Medicare prescription drug plan that
details the changes in benefits and costs to your plan for 2011. Review
these changes carefully.
Here are some tips to help you protect yourself:
Verify that the salesperson and company are licensed. It is illegal to sell
insurance in Texas without a license. To verify a license, visit the TDI
website at http://www.tdi.state.tx.us or call TDI’s Consumer Help Line at
1-800-252-3439.
Before joining a plan, always personally confirm with your doctor and other
providers that they will accept the plan. Don’t take a salesperson’s word
for it.
Don’t buy anything from a salesperson who comes to your home uninvited.
Be cautious if you’re not dealing with a trusted agent whom you’ve worked
with previously. Don’t be fooled if a salesperson claims to be with Medicare
or Social Security, even if he or she shows you an official-looking
identification card.
Be careful about giving out your Medicare number or other personal
information. While an unethical agent can use this information to enroll
you in a Medicare plan without your knowledge, you could also fall victim to
other types of fraud. You could become a victim of identity theft or you may
purchase products that are harmful or worthless to you.
Don’t sign anything you haven’t read and don’t fully understand.
Be very cautious with any advertisement or salesperson that implies they
have an “alternative” to Medicare.
Don’t believe a salesperson or agent who tells you that a Medicare Advantage
plan won’t affect your original Medicare coverage. If you enroll in a
Medicare Advantage plan, it will provide your health coverage instead of
original Medicare. Some salespeople may try to tell you that Medicare
Advantage plans are Medicare supplement insurance (commonly known as
Medigap). They are not. Medicare supplement plans fill in the “gaps” by
paying some of the costs that original Medicare won’t pay. Medicare
Advantage, however, entirely replaces your original Medicare coverage. Your
Medigap policy only works with original Medicare.
Take your time to decide. Don’t buy anything from a salesperson who tries
to pressure you into making a quick decision. Medicare offers online tools
to help you learn about your options and find a plan that’s right for you.
Visit the Medicare website at http://www.medicare.gov or call the Medicare
Help Line at 1-800-633-4227.
When meeting with salespeople, ask questions about things you don’t
understand. Take notes. Write down the salesperson’s name, address, phone
number, and anything he or she told you. It’s a good idea to have a trusted
friend or family member with you when you talk to the salesperson.
Before you enroll in a Medicare drug plan, make sure the plan covers the
prescriptions you take. Get help using the Plan Finder search tool
available at http://www.medicare.gov to review the Medicare prescription drug
benefit and the plans available to you.
Help fight Medicare fraud
If you believe you were misled or pressured into enrolling in a Medicare
Advantage plan, or were enrolled in a plan without your knowledge, you have
several options. Call the Medicare Help Line at 1-800-633-4227 and explain
what happened. Ask to re-enroll in original Medicare or to switch to
another plan that better meets your needs. Also, call the plan – not the
agent – and report the problem.
Report fraud or other agent misconduct to TDI. TDI is pursuing disciplinary
action against agents who mislead or deceive people to sell Medicare
Advantage plans. We need your help to gather information to protect you and
other potential fraud victims. To report fraud or misconduct and to file a
complaint, visit the TDI website at http://www.tdi.state.tx.us.
For more information or assistance
If you have questions or need help with an insurance question, call TDI’s
Consumer Help Line at 1-800-252-3439.
Area Agency on Aging (AAA) offices statewide can provide one-on-one
assistance to people with insurance questions or issues. To speak with an
AAA benefits counselor, call 1-800-252-9240. Your call will be routed to
the AAA office nearest you