To prevent fraud and provide structure to the Medicare program, The Centers for Medicare and Medicaid Services (CMS) have established guidelines for agent meetings, communications and compliance. As a result, it is important that you as a Medicare beneficiary identify agents that are compliant with their Medicare insurance licensing, certification and compliance.
The Rules Licensed Medicare Insurance Agents Should Follow
There are thousands of Medicare insurance agencies, call centers and independent agents who can help Medicare beneficiaries understand Medicare, the products that complement it and how to enroll. A certified, licensed Medicare agent will respect your privacy, act compliantly, ask appropriate questions, deliver the information you asked for and stay within the regulated guidelines.
When marketing Medicare insurance plans or meeting with beneficiaries, experienced, licensed Medicare insurance agents have a thorough understanding of CMS regulations, which state that agents cannot engage in any of the following actions:
- Call you on an unsolicited basis. Agents cannot reach out to you over the phone without your permission except if you’re already enrolled in a plan. In that case, it is perfectly acceptable for the agent who assisted your enrollment to call you.
- Use certain terminology that is subjective and with little or no basis in fact. For example, the CMS rules do not allow use of terms such as “the top-ranked” or “the best” relative to private Medicare plans.
- Market other types of insurance or unrelated contracts. Your Medicare insurance broker may only discuss Medicare insurance and cannot discuss unrelated matters like annuities, life insurance or homeowner’s insurance.
- Discuss or offer plans you did not express interest in. Prior to meeting with a reputable Medicare agent, you must fill out an appointment form that outlines what you want to discuss. Medicare insurance brokers must stick to the material laid out in your form unless you ask specific questions about other plans or policies.
- Suggest, advise or persuade you to choose any one particular plan. They also cannot pressure you into a particular plan by saying you may go without coverage or face astronomical medical bills.
- Ask about you or your family members’ health history, medications or other personal information.
- Charge additional fees, like administrative or enrollment fees to sign up.
- Ask for plan payment or credit card information. Once you enroll in the plan of your choice, you’ll receive a bill from the plan itself.
- Visit your home without your consent. Agents must set up a meeting with you first and receive permission to enter your home.
- Offer gifts, cash, free meals or bribes for enrolling in any particular plan.
Independent Licensed Medicare Insurance Brokers Offer Unbiased Assistance
Know your rights and the Medicare rules in place to help you make an independent plan choice. Licensed Medicare agents should only provide the educational plan material you requested, additional plan information resources, discussion on plans you’re interested in and enrollment forms you requested.
It’s important to work with a knowledgeable, licensed Medicare insurance agent. There are many reputable organizations that can assist your research and deepen your understanding of the Medicare plans available and suitable for you.