Take Control Be Informed What Every Medicare Beneficiary needs to know to survive Annual Enrollment October 2009

California Health Advocates 2 Knowledge is Power Understanding Medicare Benefits puts you in control of your Health Care. If you are satisfied with your current Medicare coverage option, simply review your plan carefully for any new changes. If you decide you want to explore more options know your rights.

California Health Advocates 3 Medicare has tightened regulations pertaining to the sale of Medicare products Historically, Sale Abuses have been prevalent. Know what sales agents can and cannot do. If you suspect Medicare Abuse or Fraud, Report it.

California Health Advocates 4 You are protected from Unsolicted Contacts 42 CFR (d) and (d)-CMS 4141-F –The rules extend existing prohibition on door- to door solicitation No –Outbound marketing calls, unless beneficiary requested the call –Calls to former members to market plans or products –Calls to confirm receipt of mailed information

California Health Advocates 5 Approaching in common areas i.e. Parking lots, hallways, lobbies, etc. Calls/visits after attendance at sales event, unless express permission given Unsolicited s Gifts cannot be given unless they are nominal and less than $15.00 in value Protections cont.

California Health Advocates 6 Plans are allowed to …. Calls are permitted to: Existing members to conduct normal business related to plan Former members for disenrollment survey Only after disenrollment effective date May not include sales or marketing information LIS-eligible members being reassigned Limited circumstances subject to advance approval Members by the agent/broker who enrolled them in the plan Beneficiaries who have given express permission Applies only to entity from whom beneficiary requested contact for duration of that transaction, or as indicated by the beneficiary

California Health Advocates 7 Beware of Cross-Selling 42 CFR (f) and (f)-CMS 4131 Providers cannot use the MA plan sales as an entry to sell you other non-health related products –Examples: annuities, life insurance If the beneficiary requests this information then it maybe provided Products to be discussed must be agreed upon completing a scope of appointment form. –Examples: Medigap, MA or PDP

California Health Advocates 8 Where can plans market? No Plan Marketing Activities in Healthcare settings –No sales activities or distribution/acceptance of enrollment forms –Examples: waiting rooms, exam rooms, hospital patient rooms, dialysis centers, pharmacy counter areas. Marketing is allowed –In common areas such as: hospital or nursing facility cafeterias, community or recreational rooms, conference rooms

California Health Advocates 9 Can plans market at Educational Events? No plan marketing activities at educational events –Event advertising materials must include disclaimer –No sales activities, or distribution/acceptance of enrollment forms and/or business reply cards Examples: health information fairs, conference expositions, state or community sponsored events Plans may distribute –Medicare and/or health educational materials –Agent/Broker business cards upon beneficiary request but cannot contain marketing information

California Health Advocates 10 Co-Branding 42 CFR (n) and (n)- CMS 4138-IFC Co-branding means that plans are not permitted to put names and logos of network partners on materials such as ID cards. –Example-No Pharmacy brand on ID card –If on other marketing materials there must be a disclaimer stating that other pharmacies are available Exceptions –Plans that have a network exclusive to that provider

California Health Advocates 11 NO FREE LUNCHES/MEALS Prospective enrollees may not –B–Be provided meals or have meals subsidized Applies at any event or meeting where –P–Plan benefits are being discussed or materials are being distributed –A–Agents/Brokers may provide Beverages or light snacks such as fruit, raw vegetables, pastries, cookies, crackers, muffins, cheese chips, etc.

California Health Advocates 12 Know with whom you are dealing If MA and PDP plans use agents/brokers they must by state-licensed If a plan terminates an agent/broker they must report this to the state in which they are appointed and the reason for termination Agent/Broker Compensation has been greatly modified to eliminate inappropriate moves

California Health Advocates 13 Protect yourself and Medicare Treat your Medicare Card like any other Credit Card, protect your identity and privacy. If it sounds too good to be true, it probably is, ask questions, get assistance before you make a decision. Beware of Free services Nothing is Free in Medicare, someone pays!

California Health Advocates 14 Resources Consumers should take their time and not make hasty decisions. HICAP TIPS line Social Security Administration MEDICARE ( ) -