Knowledge is Power

1. Take ControlBe InformedWhat Every Medicare Beneficiary needs to know to survive Annual Enrollment October 2009

2. Knowledge is Power • Understanding Medicare Benefits puts you in control of your Health Care. • If you are satisfied with your current Medicare coverage option, simply review your plan carefully for any new changes. • If you decide you want to explore more options know your rights. California Health Advocates

3. Medicare has tightened regulations pertaining to the sale of Medicare products • Historically, Sale Abuses have been prevalent. • Know what sales agents can and cannot do. • If you suspect Medicare Abuse or Fraud, Report it. California Health Advocates

4. You are protected from Unsolicted Contacts42 CFR 422.2268(d) and 422.2268(d)-CMS 4141-F • The rules extend existing prohibition on door-to door solicitation No • Outbound marketing calls, unless beneficiary requested the call • Calls to former members to market plans or products • Calls to confirm receipt of mailed information California Health Advocates

5. Protections cont. • Approaching in common areas i.e. Parking lots, hallways, lobbies, etc. • Calls/visits after attendance at sales event, unless express permission given • Unsolicited e-mails • Gifts cannot be given unless they are nominal and less than $15.00 in value California Health Advocates

6. Plans are allowed to …. Calls are permitted to: • Existing members to conduct normal business related to plan • Former members for disenrollment survey • Only after disenrollment effective date • May not include sales or marketing information • LIS-eligible members being reassigned • Limited circumstances subject to advance approval • Members by the agent/broker who enrolled them in the plan • Beneficiaries who have given express permission • Applies only to entity from whom beneficiary requested contact for duration of that transaction, or as indicated by the beneficiary California Health Advocates

7. Beware of “Cross-Selling”42 CFR 422.2268(f) and 423.2268(f)-CMS 4131 • Providers cannot use the MA plan sales as an entry to sell you other non-health related products • Examples: annuities, life insurance • If the beneficiary requests this information then it maybe provided • Products to be discussed must be agreed upon completing a scope of appointment form. • Examples: Medigap, MA or PDP California Health Advocates

8. Where can plans market? • No Plan Marketing Activities in Healthcare settings • No sales activities or distribution/acceptance of enrollment forms • Examples: waiting rooms, exam rooms, hospital patient rooms, dialysis centers, pharmacy counter areas. • Marketing is allowed • In common areas such as: hospital or nursing facility cafeterias, community or recreational rooms, conference rooms California Health Advocates

9. Can plans market at Educational Events? • No plan marketing activitiesat educational events • Event advertising materials must include disclaimer • No sales activities, or distribution/acceptance of enrollment forms and/or business reply cards • Examples: health information fairs, conference expositions, state or community sponsored events • Plans may distribute • Medicare and/or health educational materials • Agent/Broker business cards upon beneficiary request but cannot contain marketing information California Health Advocates

10. Co-Branding42 CFR 422.2268 (n) and 423.2268(n)- CMS 4138-IFC • Co-branding means that plans are not permitted to put names and logos of network partners on materials such as ID cards. • Example-No Pharmacy brand on ID card • If on other marketing materials there must be a disclaimer stating that other pharmacies are available • Exceptions • Plans that have a network exclusive to that provider California Health Advocates

11. NO FREE LUNCHES/MEALS • Prospective enrollees may not • Be provided meals or have meals subsidized • Applies at any event or meeting where • Plan benefits are being discussed or materials are being distributed • Agents/Brokers may provide Beverages or light snacks such as fruit, raw vegetables, pastries, cookies, crackers, muffins, cheese chips, etc. California Health Advocates

12. Know with whom you are dealing • If MA and PDP plans use agents/brokers they must by state-licensed • If a plan terminates an agent/broker they must report this to the state in which they are appointed and the reason for termination • Agent/Broker Compensation has been greatly modified to eliminate inappropriate moves California Health Advocates

13. Protect yourself and Medicare • Treat your Medicare Card like any other Credit Card, protect your identity and privacy. • If it sounds too good to be true, it probably is, ask questions, get assistance before you make a decision. • Beware of “Free services” Nothing is Free in Medicare, someone pays! California Health Advocates

14. Resources • Consumers should take their time and not make hasty decisions. • HICAP 1-800-434-0222 - www.cahealthadvocates.org • TIPS line 1-800-447-8477 • Social Security Administration 1-800-772-1213 • 1-800-MEDICARE (1-800-633-4227) - www.medicare.gov California Health Advocates