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Rules for Medicare health plans

People representing Medicare plans aren't allowed to:

  • Ask for your personal information (like your Social Security, bank account, or credit card numbers) over the phone.
    Note

    If you applied for Extra Help paying for Medicare prescription drug coverage, someone from the plan may contact you if any information is missing from your application.

  • Come to your home uninvited to sell or endorse any Medicare-related product.
  • Call you unless you’re already a member of the plan. If you’re a member, the agent who helped you join can call you.
  • Require you to speak to a sales agent to get information about the plan.
  • Offer you cash (or gifts worth more than $15) to join their plan or give you free meals during a sales pitch for a Medicare health or drug plan.
  • Enroll you into a plan, in general, over the phone unless you call them and ask to enroll.
  • Ask you for payment over the phone or web. The plan must send you a bill.
  • Tell you that they're Medicare supplement insurance (Medigap) policies.
  • Sell you a non-health related product, like an annuity or life insurance policy, during a sales pitch for a Medicare health or drug plan.
  • Make an appointment to tell you about their plan unless you agree in writing or through a recorded phone discussion to the products being discussed. During the appointment, they can only try to sell you the products you agreed to hear about.
  • Talk to you about their plan in areas where you get health care like an exam room, hospital patient room, or at a pharmacy counter.
  • Market their plans or enroll you during an educational event like a health fair or conference.

Independent agents and brokers selling plans must be licensed by the state, and the plan must tell the state which agents are selling their plans.

Rules for meeting with an agent

If you're going to meet with an agent, the agent must follow all the rules for Medicare plans and some specific rules for meeting with you.

During the meeting, Medicare plans and people who work with Medicare can:

  • Give you plan materials.
  • Tell you how to get more plan information.
  • Tell you about the plan options you agreed to discuss.
  • Give you an enrollment form.
  • Collect your completed enrollment form.
  • Leave business cards for you to give to friends and family.

During the meeting, Medicare plans and people who work with Medicare can't:

  • Charge you a fee to process your enrollment into a plan.
  • Steer you into a particular plan.
  • Communicate incorrect information about their plan type or use inappropriate statements like their plan is "the best" or "highest ranked."
  • Tell you about other plan options you haven't agreed to discuss, unless you specifically ask about them (to discuss these options, you need to complete a separate appointment form).
  • Pressure you to join their plan by saying things like "you have to join this plan or you won't have coverage next year."
  • Ask you to give names and phone numbers or addresses in order to sell to your friends or family.
  • Ask you to sign the enrollment form before you’re ready to join.
Note

You should only sign the form when you're ready to join.

After the meeting:

  • The plan will contact you to make sure you want to join and that you understand how the plan works.
  • The agent who helped you join the plan can call you to talk about other plan options.

Extra rules for agents selling Medicare Private-Fee-For-Service (PFFS) Plans

Agents selling Medicare PFFS Plans must:

  • Give you written information with a complete description of how the plan works.
  • Make clear that there's no guarantee that your doctor or hospital will agree to accept the plan's terms and conditions or provide you with treatment if you join the plan.
  • Send you a letter if they can't reach you by phone with instructions on how to disenroll if you change your mind.
  • Have people available to answer any questions from you, your doctor, or other providers about the plan.

How to report a plan that doesn't follow the rules