It is not always easy to tell. You should double-check everything a plan or broker tells you. For example, if a broker tells you that your doctor is part of the plan’s network, call your doctor to verify.
There are some things that are sure signs you are being misled. A broker or plan is acting illegally (committing fraud) if you have Medicare and they tell you that:
- you must sign up for a Medicare Advantage Plan, like an HMO or PPO to get Medicare drug coverage (in reality, you can keep Original Medicare and simply sign up for a stand-alone Part D plan);
- you will lose your Medicaid benefits unless you sign up for a certain plan;
- you will pay a higher Medicare Part B premium unless you sign up for a certain plan (some plans help pay your Part B premiums, but your Part B premium will not go up if you don’t join a plan);
- the only way to get information about the plan is if a plan representative comes to your home;
- the only way to sign up for a plan is if a plan representative comes to your home;
- the plan covers drugs when it does not;
- the doctors, hospitals and pharmacies you see regularly are in the plan’s network, when they are not;
- the plan offers additional benefits, such as dental or vision, that are actually covered by Medicaid, not the health plan;
- the plan covers certain services and make it sound like it is an additional benefit of the plan, when it is actually a Medicare-covered service (like mammography screenings);
- the plan offers drug coverage through the coverage gap (donut hole) when it does not;
- you can always return to Original Medicare if you are dissatisfied with the plan, without advising you about the strict enrollment periods when you can change Medicare health and drug plans.
Remember: Brokers are often paid a large fee for getting you to sign up for a Medicare Advantage Plan like an HMO or PPO.
You can avoid marketing fraud by understanding your Medicare coverage, your health and drug coverage and your rights to this coverage. In addition, it is important to understand the rules that Medicare private health and drug plans must follow when they market their products to you.
Make sure you understand what a plan is offering you, how it affects all of your Medicare and other health benefits (like Medicaid or your retiree/union coverage) and whether it covers the drugs you need before you enroll. Make sure that all of the plan’s claims are provided in writing and that you double-check all their claims.
You can tell the plan you will call them back once you have made a decision. You should never feel pressured to join any plan.
If you feel an insurance agent has not followed the rules listed above, you should save all documented proof (such as an agent’s business card or marketing materials) and report the activity to your State Insurance Department or State Attorney General Consumer Helpline.
Note: If you find out that your plan has made fraudulent claims about your health or drug coverage after the enrollment period has ended, you may be able to get a Special Enrollment Period (SEP) to disenroll from your plan and switch to another one.