Date: November 20, 2008
For more information contact: Jim Guidry, (608) 264-6239 or jim.guidry@wisconsin.gov

Medicare Advantage and Part D Open Enrollment Started on November 15. Are You Ready??

Madison, WI—New federal regulations designed to protect Medicare beneficiaries from unscrupulous marketing tactics will be in place when the Medicare open-enrollment period begins. Despite these new regulations, the Office of the Commissioner of Insurance (OCI) reminds Medicare-eligible consumers to be cautious during the upcoming Medicare Advantage (MA) and Medicare Part D (PDP) open-enrollment period, which runs from November 15 through December 31.

"I'm happy to see that the warnings from me and other state regulators on unscrupulous marketing practices were contemplated. The Centers for Medicare and Medicaid Services (CMS) have now implemented the new regulations. Still, consumers should be cautious when signing up or switching between these insurance products," said Sean Dilweg, Commissioner of Insurance. "As we all know, these Medicare Advantage products change every year and are complicated and often confusing."

Medicare is a federal program that provides health insurance for people age 65 or older and some other qualifying people. There are several options for coverage under the Medicare program. Traditional fee-for-service Medicare, also called Original Medicare, includes Part A (hospital coverage) and Part B (medical coverage - covers preventative care and outpatient care, such as doctors' office visits). Relatively recent additions to the Medicare program include Medicare Part C (Medicare Advantage - offered by private insurance companies through a contract with Medicare) and Part D (prescription drug coverage - outpatient prescription drug coverage offered by private insurance companies through a contract with Medicare). Part C and Part D are not part of traditional fee-for-service Medicare.

The new regulations issued by CMS are designed to protect beneficiaries from deceptive or high pressure marketing and sales tactics by private insurance companies and their agents during the 2009 Medicare Advantage and prescription drug open-enrollment period. The regulations include prohibitions on telemarketing and other unsolicited sales contacts. The regulations also prohibit financial incentives that could encourage agents and brokers to maximize commissions by inappropriately moving, or churning, beneficiaries from one plan to another each year.

Specifically, the new regulations would prohibit insurers and agents from:

• Providing meals to beneficiaries as part of marketing activities;
• Telemarketing, door-to-door solicitation, and other sales contacts made without a beneficiary's express invitation;
• Cross-selling of non-health care related products (such as life insurance and annuities) during any sales, marketing or presentation for a Medicare Advantage plan or Medicare Prescription Drug Plan;
• Conducting sales presentations or distributing and accepting plan applications in provider offices (such as a doctor's office or at a hospital) or other places where health care is delivered; and
• Conducting sales activities, distributing, or collecting applications at education events.

The regulations also require agents to be licensed in Wisconsin and appointed to the companies that they are selling products for.

Although Medicare Advantage plans are regulated by the federal government, the Wisconsin Office of the Commissioner of Insurance still regulates insurance agents and their behavior.

"OCI investigates agents who have been engaged in questionable marketing and sales practices," said Dilweg. "It is our job to monitor agent behavior and make sure consumers are well informed and protected from improper agent activities."

Federal and state laws prohibit agents from engaging in the following activities when selling Medicare plans. If you experience any of the following situations during the Medicare open-enrollment period, contact OCI.

• Door-to-door solicitation.
• Cold calls, if not invited to do so, if the person is on the Wisconsin and/or the national Do Not Call Registry. If this occurs notify the Do Not Call Registry.
• Offering rebates or other cash payments of any sort as an inducement for enrolling in a Medicare Part D or Medicare Advantage plan.
• Stating that a person must enroll in a Medicare Part D prescription drug plan in order to not lose coverage under Medicare Parts A and B.
• Using scare tactics to get enrollments.
• Destroying existing insurance documents, insurance ID cards or Medicare cards.
• Misrepresenting the benefits included in the Medicare Part D or Medicare Advantage plan.
• Refusing to leave a place of residence if requested to do so. If this occurs, call 911 immediately.

"The important thing for people to remember is to never make important decisions in a vacuum," said Dilweg. "Talk with a family member or someone you trust, such as an elderly benefit specialist or an area advocate for seniors, before signing anything."

If you are thinking about switching Medicare plans, know the coverages and cost-shares of the new plan compared to your current plan and be sure to check to see if your current provider will be covered under your new plan.

If you or someone in your family is a Medicare beneficiary and you have questions regarding agent activity or wish to file a complaint involving an agent, contact OCI at 1-800-236-8517. Further information and complaint forms are also available at the OCI Web site: oci.wi.gov.

Created by the Legislature in 1871, Wisconsin's Office of the Commissioner of Insurance (OCI) was vested with broad powers to ensure that the insurance industry responsibly and adequately met the insurance needs of Wisconsin citizens. Today, OCI's mission is to lead the way in informing and protecting the public and responding to its insurance needs.