What Are the Marketing Rules for Medicare Plans?

Alice MurphyMedicare AnswersLeave a Comment

Dear Marci,

I volunteer at a local senior center and I have Medicare myself. With Medicare’s Fall Open Enrollment coming up, I know that Medicare plans will be advertising. What rules do these plans have to follow? What should we do if plans break these rules?Cindy (Bridgeport, CT)

Dear Cindy,

Insurance companies selling Medicare private plans (which include Part D and Medicare Advantage plans) must follow certain rules when promoting their products. These rules are meant to prevent plans from presenting misleading information about a plan’s costs or benefits. This is also known as marketing fraud.

Medicare private plans are allowed to conduct certain activities. For instance, companies can market their plans through direct mail, radio, television, and print advertisements. Plans can also send emails, but they must provide an opt-out option in the email for people who do not wish to receive them. Agents can also visit your home if you invite them for a marketing appointment.

Insurance agents cannot:

  • Call you if you do not give them permission to do so
  • Visit you in your home, nursing home, or other place of residence without your invitation
  • Ask for your financial or personal information (like your Social Security number, Medicare number, or bank information) if they call you
  • Provide gifts or prizes worth more than $15 to encourage you to enroll. Gifts or prizes that are worth more than $15 must be made available to the general public, not just to people with Medicare
  • Disregard federal and state consumer protection laws for telemarketing, the National Do-Not-Call registry, or do-not-call-again requests
  • Market their plans at education events or in health care settings (except in common areas)
  • Sell you life insurance or other non-health products at the same appointment (known as cross-selling), unless you request information about such products
  • Compare their plan to another plan by name in advertising materials
  • Use the term “Medicare-endorsed” or suggest that their plan is a preferred Medicare plan
    • Plans can use Medicare in their names as long as it follows the plan name (for example, the Acme Medicare plan) and the usage does not suggest that Medicare endorses that particular plan above other Medicare plans
  • Imply that they are calling on behalf of Medicare

If you feel a plan or agent has violated Medicare’s marketing rules, you should save all documented proof, when available, such as an agent’s business card, the plan’s marketing materials, and your phone call records. Report the activity to 1-800-MEDICARE or your local Senior Medicare Patrol (SMP). To contact your SMP, call 877-808-2468 or visit www.smpresource.org.

-Marci

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