Rules for Medicare Advantage Plans
Posted on August 30, 2014 by bob in Medicare
Dear Marci,
I have received mail lately about different Medicare Advantage plans. Do Medicare Advantage plans have to follow any rules 
when marketing their plans to me?—James
Dear James,
Yes, there are specific guidelines that companies selling Medicare Advantage plans and Medicare Part D plans must follow when promoting their plans to you. These guidelines are meant to prevent marketing fraud, or deception about what a plan offers and how much it costs. Companies are allowed to market their plans through direct mailings and television, radio, and print advertisements. However, plans are not allowed to:
— call if you did not ask them to do so;
— send unsolicited e-mails. You must specifically requested information for a plan to e-mail you;
— visit your home or nursing home without an invitation. You can ask the plan to send someone, but they cannot just knock on your door uninvited;
— ask for financial/personal information if they call. Beware if asked for your SSN, Medicare number or your bank information;
— provide gifts or prizes worth more than $15 to encourage you to enroll;
— disregard the National Do-Not-Call Registry and do not call again requests;
— market their plans at educational events, in health care settings or at locations and events where free meals are provided;
— sell you life insurance/other non-health related products at the same appointment. This is “cross selling” and it is prohibited unless you request the non-health related product information;
— compare their plan to another plan by name in advertising materials;
— include the term Medicare Endorsed or suggest it is a preferred Medicare drug 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 Medicare endorses that particular plan above any other Medicare plan;
— imply they are calling on behalf of Medicare. Plans are not allowed to give you the impression Medicare asked them to call you.
To report fraud you contact either 1-800-MEDICARE (800-633-4227) or the Inspector General’s fraud hotline, 1-800-HHS-TIPS (800-447-8477).When Medicare investigates potential fraud, your name is not used if you do not want it to. —Marci
Dear Marci,
I think my monthly income is a little over the income limit for a Medicare Savings Program. Should I still apply anyway?
— Alexander
Dear Alexander,
Yes, even if your income is above the guidelines for a Medicare Savings Program (MSP), you should still apply. You may still qualify for an MSP because certain income and assets may not count. Each state has its own formula for counting your income and assets to determine eligibility for an MSP. In all states, the following income is never counted:
— first $20 of all income;
— first $65 of monthly wages;
— 1/2 your monthly wages (after the $65 is deducted);
— food stamps.
Some states may not count other income, and/or may exclude things from your income, such as the money you use to pay health insurance premiums (like Part B premiums). Also, if there are more than two people in your household, the monthly income limit may be higher in some states.
In all states, the following assets are never counted:
— your primary house;
— your car;
— household goods and wedding/engagement rings;
— burial funds for you and your spouse valued up to $1,500 each;
— life insurance with a cash value of less than $1,500.
Many states do not count other types of assets, and some states have no asset test.
To find out your state’s guidelines for determining eligibility for an MSP, contact your local State Health Insurance Assistance Program (SHIP). To find the contact information for your SHIP, you can go online and visit www.shiptalk.org.—Marci
Marci’s Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. “Dear Marci,” a free educational e-newsletter, is available from the website.
