HELP LINE: There are things Medicare salespeople can’t do

LAST WEEK, I shared a list of things to do, not do or know about our new Medicare cards; then I got another list (I know, but I absolutely refuse to make a list to keep track of my lists).

This list has to do with things that people who are selling “Medicare plans” can’t do in the course of selling you said plan.

Let’s begin with, what the heck is a “Medicare plan?”

Good question.

I think it’s a generic reference to, primarily, Medicare Part D plans and Medicare Advantage Plans (aka, “Part C” or “Medicare health plans”), the latter not being a biggie for most of us, because there are almost no Advantage plans in our region.

But, it happens.

It might also include Medicare supplement plans (aka, “MediGaps”), depending on how one wishes to interpret it, but I’d say the focus is on Part D and Advantage Plans.

So, here’s Mark’s boiled-down list of the “Things that Medicare Plans and People Who Represent Them” can’t do:

• They can’t charge you a fee to process your enrollment into a plan and they can’t pressure you by saying something like, “You have to join this plan or you won’t have coverage next year.”

If you hear either of those, you’re being scammed.

• They can’t send you unsolicited emails and they can’t come to your home — uninvited — to try to sell you a plan.

So, if the doorbell rings and some yahoo says, “We’re working in the neighborhood and happen to have some extra Medicare plans, so we can give you a heck of a deal.”

Smile knowingly and close the door.

• They can’t call you, unless you’re already a member of the plan or you gave permission to be called.

If you are a member, the agent who helped you join can call you and they can’t enroll you into a drug (Part D) plan over the phone unless you call them and ask to enroll.

IMPORTANT: They can’t ask you for payment over the phone or internet.

The plan must send you a bill.

• They can’t make an appointment to tell you about their plan unless you agree, in writing or through a recorded phone discussion, to the product(s) being discussed and they can only try to sell you the products you agreed to hear about.

Let’s stop a moment, because that last one is a biggie and it does happen.

These folks cannot sell you some other product, such as an annuity or life insurance policy, in the course of selling a Part D or Part C plan.

Now, if you want to hear about (or buy) something like that, go for it.

But, the Medicare plan conversation can’t magically morph into something else.

I’ve seen this happen to people, and it can get ugly, stressful and expensive real quick, so please pay attention.

• They can’t offer you cash to join their plan or give you a free meal while trying to sell you a plan — stop.

The latter is a very common sales technique: “Come join us for a free gourmet meal at Jim Bob’s Hot Dog Haven and learn all about how to successfully flush your money down the toilet.”

That’s a perfectly legal technique (NOTE: “legal” and “ethical” are not the same thing) and if you want to go, go — but not for Medicare health plans.

• They can’t try to sell you their plans or enroll you during an educational event, such as a health fair or conference or whatever.

They can talk to you about their plan(s), but sell them? No.

• And they can’t talk to you about their plan in areas where you get health care, such as a hospital room or exam room.

I know what you’re thinking, because I saw the same picture: You’re sitting on the table in the exam room, swinging your legs to avoid thinking about the “gown” you’ve been draped in, and in comes some suit with a briefcase, fast-talking insurance.

I don’t think so.

• They can’t ask for your Social Security number, bank account number or credit card information, unless it’s needed to verify membership, determine enrollment eligibility or process an enrollment request, so if you get asked for any of those things, be darn sure you know why.

• And they can’t ask you for names and phone numbers/addresses of your friends and family, to try to sell to them.

That’s pretty much it.

Some of that seems elementary? OK, good.

But I’ve seen every single one of those happen to people, right here in our own backyard, so pay attention.

What do you do if any of those do happen?

First, don’t go for it or allow it.

Then, call 1-800-633-4227 (Medicare) and report it — TTY 1-877-486-2048.

You can also call the Medicare Drug Integrity Contractor (if this is about a Part D plan) at 1-877-772-3379, because they specialize in this sort of thing.

You’ve probably noticed, and I’m sorry to say, that none of this forbids burying us under mounds of junk mail.

And way too often, that junk mail can look awfully “official,” because it’s designed to look that way.

So, sometimes it can be hard to tell what’s what.

If that happens to you, call any of the numbers at the end of this column and decent people will help you sort it out, for free.

And I know, for a fact, that they (we) won’t try to sell you anything, because they (we) don’t have anything to sell.

I refuse to say anything more about “gowns.”


Mark Harvey is director of Clallam/Jefferson Senior Information & Assistance, which operates through the Olympic Area Agency on Aging. He is also a member of the Community Advocates for Rural Elders partnership. He can be reached at 360-452-3221 (Port Angeles-Sequim), 360-385-2552 (Jefferson County) or 360-374-9496 (West End), or by emailing [email protected].

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