People representing Medicare plans aren't allowed to:
- Ask for your personal information (like your Medicare, Social Security, bank account, or credit card numbers) over the phone unless it’s needed to verify membership, determine enrollment eligibility, or process an enrollment request.
- Come to your home uninvited to sell or endorse anything.
- 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.
- Ask you for payment over the phone or online. 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. 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 about the plan options and how to get more plan information.
- 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 so they can sell to your friends or family.
- Ask you to sign the enrollment form before 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.