Medicare Open Enrollment brings a wave of mail, ads and phone calls. Some of it is useful. Some of it is pushy, and a small share is outright fraud. Knowing what plans and agents are and are not allowed to do makes it much easier to sort the helpful contact from the kind you should hang up on.
Open Enrollment runs from October 15 to December 7, and any change you make takes effect January 1. The plan has to receive your enrollment request by December 7, so there is time to make a careful choice. Nobody should be rushing you.
Unsolicited Calls and Texts
According to Medicare.gov, plans and their representatives are not allowed to call or text you unless you are already a member of that plan or you have given permission. If a stranger calls out of the blue claiming to have a better Medicare plan for you, that alone is a warning sign.
There is a narrow exception. If you applied for Extra Help with prescription drug costs, someone from the plan may contact you about missing information on your application. Even then, you can hang up and call the plan back using the number on your card or its official website.
Home Visits and Appointments
Plans and agents cannot come to your home uninvited to sell you something. They also cannot set up an appointment to tell you about a plan unless you agree to the meeting and complete an appointment form, and they can only discuss the types of products you agreed to hear about.
If you want an agent to meet you at home or at your kitchen table, that is perfectly fine. The point is that you make that choice, not the salesperson.
What They Cannot Ask For or Offer
Medicare.gov lists several things that should make you stop and think twice.
- Asking for bank or credit card numbers just to give you a quote.
- Asking you to pay a premium over the phone or online during the sale. The plan is supposed to send you a bill.
- Offering cash, gifts worth more than $15, or free meals as an incentive to join.
- Charging an enrollment fee.
- Selling unrelated products such as annuities or life insurance during a Medicare plan sales pitch.
- Talking to you about a plan where you get health care, such as an exam room, hospital room or pharmacy counter.
Your Medicare number deserves the same care as a bank card. Only share it with someone you have chosen to work with and are ready to enroll through.
What a Licensed Agent Is Allowed to Do
None of this means you should avoid agents. Independent agents and brokers must be licensed by your state, and a good one saves you time and helps you avoid costly mistakes. During a meeting, an agent can give you plan materials, explain your options, hand you an enrollment form, collect a completed form and leave a business card.
What they cannot do is pressure you, steer you toward a particular plan, give you misleading information, or ask you to sign before you are ready. Medicare’s own guidance is to sign an enrollment form only when you are ready to join.
Questions to Ask Anyone Selling a Plan
A short list of questions can tell you a lot about who you are dealing with.
- How many insurance companies and plans do you represent in my area? Agents are required to tell you this before discussing specific plan benefits.
- Are my doctors and hospitals in network for this plan next year?
- Are my prescriptions on the plan’s drug list, and at what tier?
- What will this plan cost me in a bad year, not just a good one?
- Can you put the details in writing before I decide?
If someone avoids these questions or gets impatient when you ask them, that tells you what you need to know. Our Medicare FAQ covers more of what to ask.
Advertising Red Flags
Plan advertising also has rules. Ads have to include the specific plan type, such as HMO or PPO, in the plan name. They cannot use inaccurate, misleading or confusing information or images, including misuse of the Medicare name, logo or card. A mailer designed to look like an official government notice deserves a second look before you respond.
If You Think You Were Misled
If you believe an agent or plan misled you when choosing coverage, Medicare can help. Call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, 7 days a week except some federal holidays. TTY users can call 1-877-486-2048. You can also use the chat option on Medicare.gov.
If the change has already been made, do not assume you are stuck. Depending on your situation there may be options to fix it, and it is worth getting help quickly.
Getting Help You Asked For
The simplest way to avoid high pressure sales is to choose who you talk to. We are a local Knoxville agency, we meet by appointment, and we compare plans from multiple carriers so you can see your options side by side. You can read about our Medicare services, see which type of plan may fit you, or learn more about Medicare help in Knoxville. When you are ready, schedule a free consultation and we will walk through your options before December 7.
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