During Open Enrollment, which runs from October 15 to December 7 each year, Medicare plans, both regular PDP and Medicare Advantage, market to people that are eligible for Medicare. It's important to remember the rules that are in place to stop plans from inappropriately marketing towards your patients and to know what to do if you think plans are breaking these rules.

Medicare has rules for how plans can contact you in different situations:

  • By mail, radio, and print advertisements: Plans are allowed to market themselves by any of these means. They cannot, in these advertisements or in any other marketing situation, suggest that they are endorsed or preferred by Medicare. Plan names can include the word Medicare as long as it follows the name of the insurance company and it does not suggest that Medicare endorses that particular plan over any other plan.
  • By phone or e-mail: A plan may not call or email patients without their permission. Plans may only give them their contact information if they request it and if this is the case, the patient must be the one to call the plan. If a patient gives their contact information to a plan, they may be giving the plan permission. Plans must also follow federal and state regulations related to marketing over the phone – they cannot ignore the Do Not Call Registry and do not call again requests, and they cannot call late at night or early in the morning.
  • In person: Plan representatives cannot approach patients in public places or come to their home or nursing home uninvited. If a patient goes to a plan’s educational or marketing event, or agree to meet one-on-one with a representative, there are rules the representative must follow. At educational events, insurance companies cannot hand out marketing materials, plan-specific cost information, or a plan representative’s contact information. At a marketing event, an insurance company can provide information about a specific plan, but they cannot require the patient to provide contact information, give the patient a health screening, or create a situation that suggests they only want to enroll healthy people. Plans cannot offer gifts worth more than $15 at either kind of event and they can only serve meals at educational events, not at marketing events. Additionally, any gifts that plans offer must be available to all attendees, not just those who enroll. Plans cannot offer benefits (such as a free checkup) as gifts. At a one-on-one meeting: A plan representative can only schedule a meeting with the patient's permission. At this meeting, the plan agent or broker is only allowed to talk to the person who has the appointment. Before the meeting, the patient must formally indicate the topics they would like to discuss and the plan representative or broker cannot tell them about products or plans that fall outside of that scope, unless the patient gives them further formal permission.

What's Next?

If you think a plan is engaging in a marketing violation, you should save any proof that you have. You can report violations to Medicare by calling 1-800-MEDICARE, or to your Senior Medicare Patrol (SMP) by visiting www.smpresource.org or calling 877-808-2468.

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