TRENTON – New Jersey Department of Banking and Insurance (DOBI) Commissioner Tom Considine today warned consumers and health care providers to beware of unscrupulous or fraudulent activities during the annual Medicare open enrollment period which runs from October 15 through December 7, 2011.
“Open enrollment can be a confusing process, and unfortunately during this time there are some bad actors who seek to take advantage of senior citizens who rely on Medicare for their health care needs,” said Commissioner Considine. “If seniors follow some basic, common-sense precautions, they can avoid fraud, make smart choices and choose the product that is best for them.”
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 annually and it is up to each beneficiary to choose whether to keep their current plan for the upcoming year or change to a new plan.
Commissioner Considine urged consumers to be aware of the rules CMS adopted 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. The rules say that 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 and
- May not offer you gifts or other promotional items with a value greater than $15.
Commissioner Considine also offers these additional tips to combat fraud and abuse:
- Consider your options carefully before making any changes to your Medicare coverage. Consumers should have received a notice from their Medicare Advantage or Medicare prescription drug plan that details the changes in benefits and costs to their plan.
- Verify that your salesperson and company are licensed. This can be verified through the Department’s web site at: https://www16.state.nj.us/DOBI_LicSearch/insSearch.jsp. For inquiries or complaints, consumers can call either (609)-292-7272 or the Department Consumer Hotline 1-800-446-7467.
- Check that the plan you have chosen is an approved Medicare plan. All plans are listed at www.medicare.gov or available by calling 1-800-MEDICARE (1-800-633-4227).
- Before enrolling in a Medicare drug plan, you should make sure the plan covers the prescriptions you take. Get help using the Plan Finder search tool available at www.medicare.gov to review the Medicare prescription drug benefit and the plans available to you.
- Before joining a plan, always personally confirm with your doctor and other providers that they will accept the plan.
- Do not buy anything from a salesperson who comes to your home uninvited.
- If you are dealing with an unfamiliar agent who has never previously worked with you, be especially cautious. Do not 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 as this could lead to a consumer being enrolled in a Medicare plan without their knowledge or becoming a victim of identity theft.
- Do not believe a salesperson or agent who tells you that a Medicare Advantage plan will not 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); however they are not. Medicare supplement plans fill in the “gaps” by paying some of the costs that original Medicare does not pay. Medicare Advantage, however, entirely replaces your original Medicare coverage. Your Medigap policy only works with original Medicare.
- When meeting with salespeople, ask questions about things you do not understand. Take notes. Write down the salesperson’s name, address, phone number, New Jersey license reference number and anything he or she told you. It is a good idea to have a trusted friend or family member with you when you talk to a salesperson.
- Anyone who suspects fraud or abuse should contact the Department at 1-800-446-7467 or file a complaint online at: www.nj.gov/dobi/.
- For more information on Medicare coverage or to get help with a Medicare issue, call the State Health Insurance Assistance Program (SHIP) at 1-800-792-8820 or go online at: www.state.nj.us/health/senior/ship.shtml.
“There are a lot of details to consider in choosing a plan,” said Commissioner Considine. “Consumers can find some information on state, federal and health care provider web sites and some by simply asking direct questions to providers, doctors and salespeople. Consumers should gather all the information they can and not be shy about asking questions as they make this decision.”