How to Avoid Medicare Marketing Traps: What to Watch Out For

The popularity of Medicare Advantage (Medicare Part C) continues to grow and may become the prevailing choice of over 50% of Medicare beneficiaries in 2023. Kaiser Family Foundation reports that enrollment grew from 19% in 2007 to 48% in 2022.

Two-thirds of Medicare Advantage beneficiaries have individual plans that qualify for plan changes each year during the Open Enrollment Period (OEP) from October 15 to December 7. They will be the target of private insurers who administer, market, and sell Medicare Advantage and Part D plans. Although the Centers for Medicare & Medicaid Services (CMS) provides marketing guidelines for these plans, the temptation is too great for some bad actors who rely on manipulative and deceptive sales strategies to enact Medicare Part C scams, along with all other Medicare plans.

A U.S. Senate Committee on Finance report in late 2022 says that the number of marketing complaints CMS received more than doubled from 2020 to 2021. CMS has recently tightened some of its guidelines. Still, the best protection continues to be an educated consumer — and educating you is the goal of this article.

Most plan sponsors and their representatives — including agents, brokers, and third-party marketers — follow strict guidelines when approaching beneficiaries about Medicare. Unfortunately, some have less integrity and can try to mislead you in several ways, including:

• In-person
• As television ads
• Through telemarketers
• As robocalls

As a result, you may discover that your Medicare plan was switched without your knowledge, or the plan you chose may not include what you expected. You may be missing promised additional benefits like vision and dental care. Your doctor’s office may also notify you that they're not in your network, which would mean having to pay out-of-network charges to stay with that doctor or find a new one. If your Part D prescription drug plan was switched, you might be surprised by the cost of current medications.

If you don't catch the deception in time, you could be stuck with that plan until next year's Open Enrollment Period. Fortunately, CMS now allows for a Special Enrollment Period if you want to leave your plan due to deceptive sales tactics, including misleading or incorrect information, or if you were enrolled into a plan without your knowledge.

Unscrupulous scammers have countless ways to try to take advantage of you. Here's how to identify a scammer:

• A company explicitly says it represents Medicare, Medicaid, or Social Security
• A company you don't know calls you unsolicited
• An agent calls or shows up at your house uninvited
• Leaflets, flyers, or door hangers appear on your car or front door from a company you have no relationship with
• An agent, a television ad, or literature makes promises that sound too good to be true
• Someone tells you your current coverage is being discontinued and proposes alternatives
• Someone uses pressure or makes you feel bullied into quickly making a decision before you're ready
• A caller asks for information such as your Medicare ID, Social Security, or bank account number

According to CMS regulations, no one should reach out to you unsolicited — in person, by phone, or by email — except for agents you're already working with or who signed you up for your current plan. Fraudsters and scammers also may aim to get enough personal information to commit fraud, steal your identity, or switch you to another plan to earn a commission.

Let's take a look at some of the more common means.

Cold calling by health care marketers is prohibited by law, yet the number of callers (including robocalls) using misleading Caller IDs proves that these laws are being ignored. Please understand that you are being manipulated, no matter what is being offered — whether promises of free health services, gifts, exclusive benefits, or anything else.

One way marketers get around the no-cold-calling restriction is for companies to send out enticing mailers that look like official notices from the Internal Revenue Service (IRS) or Medicare. If you initiate a contact from advertisements, the CMS prohibitions are no longer in effect.

Misleading advertising can range from false claims of endorsement by the government to not being truthful about plan benefits. These false advertising materials may seem to bear government logos or be designed like a familiar government document. A company's branding could also include the word “Medicare” in a way that fools you into assuming an incorrect endorsement.

Enticing television commercials can run in broad media markets but tout benefits available only in certain states or counties. One common ploy offers "money back into your Social Security account" as a refund of your Medicare Part B premium. It's available to very few, but it triggers curious calls for more information, and now the door to more marketing is open.

Agents may use pressure tactics after "investing" the time to explain available plans to a potential customer, feeling the investment entitles them to something. It entitles them to nothing. No matter what they say — even if someone becomes belligerent — understand that you cannot be forced into enrolling in a plan before you are ready.

Pressure tactics using threats of limited opportunities, closing doors, and time-limited offers are playing on the "fear of missing out," or FOMO. Know that Medicare opportunities are available equally to all, and enrollment deadlines are transparent and predetermined. You have ample time to research unless you wait until the last minute.

Medicare Advantage beneficiaries are not the only ones targeted by scammers. Original Medicare beneficiaries may be told forcefully they're not getting all the benefits they're entitled to, then find themselves moved unknowingly to a Medicare Advantage plan. That enrollment cancels Medigap plans, which can be very difficult to reinstate. Why are they pushing Medicare Advantage plans? Because they can earn a commission.

You may ask, "Are Medicare Advantage plans too good to be true?" Only if you are talking to someone who is not presenting one truthfully.

To make a sale, the person selling a plan may make it sound like it meets everyone's needs — including yours — but that isn't the case. In fact, Medicare Advantage plans are plentiful enough to be tailored to the customer's needs, wants, and budget. It's easy for an agent to confuse you with endless details on coverage, doctors, or access to current medications, so the most reliable recourse is to require information in writing.

Another sales tactic is to guarantee no disruption to your current treatment due to a plan change, including access to specialists and covered medications. Despite your pointed questions, you may learn later that the information provided was incorrect. Another strategy is to save you money by switching to a lower-cost plan, supposedly with no loss of benefits, only to discover that you have no prescription drug or some other coverage.

Promises of lower costs — such as $0 premiums — may fail to mention that Medicare Part B premiums must still be paid, as must copays for doctors and specialists. Representatives may give false answers to questions about specific doctors and medications, leading to costly out-of-pocket charges for out-of-network doctor visits and nonexistent drug coverage.

With medical identity theft, someone may use your personal information to visit a doctor, get prescription medications, submit claims to your insurer, or get other medical care. It can affect your access to care in the future.

Besides filing false claims, scammers who access your information can enroll you in a plan you didn't select or steal your identity outright. The need to protect your personal information can't be overstated.

Scammers are also known to hack medical databases containing extensive personal information about existing Medicare beneficiaries, including medical histories. This makes it far easier for them to sound convincing when trying to obtain further personal information from potential scam victims.

Education is the best protection against being misled. If you're comfortable on a computer, spend time on the Medicare.gov website to understand what plans are available in your zip code. If you plan to use an agent or broker, ask friends and family to refer trusted ones. Ask those friends and family about their experience with the enrollment process so it becomes more familiar to you. And before enrolling, get in writing any promises made, and confirm with your preferred doctors that they are in the plan's network.

Your Medicare coverage is supposed to be there for you as you age and experience increased needs for medical care. You don't want to discover that it isn't there because of Medicare fraud when you signed up.

Your first critical decision will be if you want to remain with Original Medicare or replace it with a Medicare Advantage plan. With Medicare, you'll want to look into optional Medigap and Medicare Part D prescription drug plans. With Medicare Advantage, you'll want to explore and compare all available options in your zip code. The best tool for initial research is the Medicare.gov website.

Before deciding on a plan, understand precisely what it will and won't cover. Analyze all the relevant costs: premiums, deductibles, copayments, and coinsurance. With Medicare Advantage, examine the plan's network and see if your preferred providers are included. For Part D prescription drug plans, ensure your current medications are covered and affordable.

Health care marketers are prohibited by law from cold-calling you. Particularly during the Open Enrollment Period, calls can be constant and may use fake Caller IDs to trick you into answering. If you receive unsolicited calls, hang up or do not answer. Under no circumstances do you want to give a caller any personal or Medicare information — as no one with good intentions will ask you for it.

There’s no such thing as asking too many questions. As long as you have any doubts, keep asking. You want to understand all aspects of the plan, from the insurance company's obligations, such as benefits and services, to your personal obligations, including out-of-pocket costs and using providers within the network — or paying more.

Medicare is complicated, with a series of decisions to be made at various levels. And, unlike health care decisions in earlier years, some decisions can define your access to care for the rest of your life.

Even if you've studied Medicare's options, you can benefit from the expertise of a trusted expert, especially when unbiased expertise comes at no cost. Such experts can be found at your State Health Insurance Assistance Program (SHIP).

Another resource is a Medicare advisor. It can take many hours to understand your options on your own. A call to a company like OpenMedicare can make that additional effort unnecessary by sharing extensive Medicare expertise with you.

Health insurance agents and brokers are professionals trained to help you enroll in a Medicare plan after carefully listening to your preferences. With their help, you can explore and compare your options. Remember that an agent typically works for a single company, and a broker works for multiple companies. Be sure to ask what companies are represented so your options are not limited.

Agents and brokers must be licensed in your state, and there should be no cost to you for their help as they're compensated by the insurance company sponsoring the plan you purchase. If possible, determine if the agent or broker is compensated differently based on what plan you select. You want the best plan for you and not for the intermediary.

The Medicare advisor you select can have a strong influence on the success of your selection. Here are some common questions you can ask to help decide who to work with.

• Do you work with just one company or more?
• What company or companies?
• What is your experience selling Medicare plans?
• What types of plans can you sell: Medicare Advantage? Medigap? Prescription drug?
• How broad a range of plans will you look at for me: all available to me or just some?
• What access do I have if I have more questions?

Medicare agents or brokers must follow the federal rules established by the CMS and any relevant state insurance rules. Their role is somewhat limited: they can provide materials and information about Medicare plans, give out enrollment applications, and collect them once completed.

The list of what they can't do is much longer. They can't:

• Come to your house uninvited or call if you fail to join a plan
• Ask for personal information during a phone call that isn't required to enroll you in a plan, including credit card or bank information
• Provide you with any incentives, including money and gifts
• Charge you to process your enrollment into a plan
• Talk about any other type of insurance than Medicare plans
• Steer you towards a specific plan, saying it's the best
• Misinform you about plans
• Pressure you to sign before you're ready
• Ask you to refer people they can contact

Only sign up for a plan if you have no doubts about that plan or the broker working with you. You can always check your options on Medicare.gov.

If, at the end of the Open Enrollment Period on December 7th each year, you find yourself locked into a plan you want to change, you can switch during the Medicare Advantage Open Enrollment Period from January 1 to March 31 of the following year.

Sometime in the fall, you may catch yourself saying, "Why am I getting Medicare junk mail?" – and you'll know Open Enrollment season is not far off. It's when you can change your Medicare Advantage or Part D prescription drug plan. It's also important to recognize that this time of year is when health care fraud is at its highest.

OpenMedicare's goal is to add transparency to the Medicare search. We provide customers with what they need to know to avoid falling victim to Medicare marketing traps and select the best health plan for their needs. By calling us at (844) 910-2061, you'll have a seamless experience that gives you the peace of mind of knowing you have great Medicare coverage.

Please note that we do not always offer every available plan in your area. As a result, any information we provide is limited to the plans we do offer. Please contact Medicare.gov or 1–800–MEDICARE for information on your options.