1. Know what to expect

Medicare has rules about how it interacts with Medicare beneficiaries and rules for plan representatives and insurance agents when they speak with Medicare beneficiaries about plans.

Knowing what to expect from each way you interact with Medicare will make it easier to spot scammers, which will save you a headache.

Below are many important things to know about interacting with Medicare and some red flags to notice. More information about what to expect can be found on Medicare.gov.

Medicare

You won’t receive home visits or sales calls from government employees of Medicare. If you want to enroll in Parts A and B over the phone, you have to call Medicare first.

You also won’t get calls from Medicare asking for personal information unless you’ve already given permission to be contacted for this.

Red Flags:

  • Someone you don’t know, stops by your house or calls you and claims to be from Medicare.
  • Someone claiming to be from Medicare asks for personal information or contacts you about enrolling in a plan.

Helpful Tip: When you receive a call from a Medicare Advocates, they are returning your request for information and will always clearly state that they are part of our team.

Medicare plan representatives

Medicare plan representatives won’t market plans at in-person educational events, health care facilities, or at your home uninvited. They also don’t offer cash or gifts over $15 or provide free meals during a sales pitch.

Medicare plan representatives don’t collect payment when you enroll. The Medicare plan will send you a bill in the mail.

After you’ve enrolled in a plan, you can be contacted by the plan or the agent who helped you enroll. You may be asked for personal information if needed to verify your plan membership.

The plan will send you a bill in the mail. The agent shouldn’t ask you to make a payment right then or over the phone.

Red Flags:

  • An agent gives you a sales pitch and offers a free meal or a large incentive for enrolling in a plan.
  • You attend an in-person education event that ends up having strings attached

Insurance agent meetings

When you speak with an insurance agent, you’ll receive plan details and information about where to learn more. You’ll only hear about the Medicare plans you ask about and may need to complete a Medicare Scope of Appointment form before your appointment. You also won’t hear sales pitches for non-health related products.

During the meeting you may be asked for personal information to check eligibility or complete enrollment. You can also receive or return an enrollment form during a meeting with an agent.

You won’t have to deal with processing fees, pressure, manipulation, or hear plans described as “top-ranked.”

Keep in mind that Medicare rates Medicare Advantage and prescription drug plans annually. You should ask about these ratings, and you may hear that a plan has a good star rating from Medicare. However, these ratings don’t identify a plan as “best” or “top-ranked”.

Red Flags:

  • You meet with an agent and hear about Medicare plans you never expressed interest in or hear about non-health related products like life insurance and annuities.
  • You are asked to pay a processing fee to the agent.
  • You are being pressured or manipulated into a specific plan.
  • The agent uses language like “best” or “top-ranked” to describe a plan.

Additional rules apply to agents selling Medicare Private-Fee-For-Service (PFFS) plans.

2. Keep sensitive information need-to-know

Sensitive information includes your Medicare number, Social Security number, and health information. Scammers are after these details for fraud.

Be sure that anyone you share this information with has a legitimate reason to have it. For example, your doctor needs your health information to give you medical advice and care. Your doctor also needs your Medicare number so they can bill appropriately.

If you’re unsure about sharing the information with someone, wait to share it. Double-checking with a trusted friend or family member before sharing information can help you protect yourself.

3. Be wary of free or unnecessary health services

Don’t believe claims of free health services. If someone is offering free health services and needs your Medicare information, they may be planning to charge Medicare for the health services. You don’t want to participate in fraud even unwittingly, so avoid pursuing free health care.

You’ll also want to make sure you only receive needed health care services. Receiving unnecessary care is also considered fraud. Work with trusted doctors and ask questions about recommendations to be sure you understand your health needs.

4. Reconcile Medicare statements with personal records

Pay attention to your billing statements and reconcile them with the care you actually received. If you see any discrepancies, you can contact the hospital or doctor’s office to get more information. They can fix a billing error if there is one.

If you are a client of Medicare Advocates, you can always contact the Client Service Team to help you resolve billing issues or errors.

If the discrepancies aren’t explained by billing errors, you can report fraud to Medicare.

Understanding what to expect from Medicare and Medicare plan representatives will make it easier to identify suspicious behavior and avoid scams. You’ll also be able to identify a good insurance agent and agency, which will help you be confident when working with them.

Being cautious when sharing personal information and avoid free or unnecessary health services also helps prevent fraud. Reviewing your statements with services you actually received will help you catch billing errors and fraud.

 

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