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State Officials Caution Seniors to Be Alert for Fraud During Medicare Open Enrollment

Seniors should beware of unscrupulous or fraudulent activities during the annual Medicare open enrollment period, which runs from Oct. 15 through Dec. 7, 2012.

Editor's Note: The following is a news release issued by the New Jersey Department of Banking and Insurance.

New Jersey Department of Banking and Insurance (DOBI) Acting Commissioner Ken Kobylowski and Department of Human Services (DHS) Deputy Commissioner Lowell Arye recently urged consumers and health care providers to beware of unscrupulous or fraudulent activities during the annual Medicare open enrollment period, which runs from Oct. 15 through Dec. 7, 2012.

“Senior citizens face many important choices during the Medicare open enrollment period, such as whether to maintain their current insurance carrier, whether their current level of coverage is adequate and much more,” said Acting Commissioner Kobylowski. “Before making a decision, they should review as much information as possible by looking at federal, state, insurance company, and health care provider websites and by asking direct questions to doctors, salespeople and carriers.”

Private companies that contract with the federal Centers for Medicare and Medicaid Services (CMS) offer Medicare Advantage and Medicare Part D drug plans. The plans change annually and it is up to each beneficiary to choose whether to keep their current plan for the upcoming year or change to a new plan.

“We encourage seniors with questions to trust the knowledgeable volunteers that provide free Medicare counseling through the State’s Health Insurance Assistance Program (SHIP),” said DHS Deputy Commissioner Lowell Arye, who oversees the Divisions of Aging Services and Family Development. “They provide the most up-to-date information about the technical aspects of Medicare in a way that makes sense and allows seniors to determine which plan is best suited to their needs.”

Acting Commissioner Kobylowski urged consumers to be aware of the rules CMS adopted to guide sales practices and to protect consumers from improper marketing activities. The rules apply to all Medicare plans, agents, and any contractors who work for these plans. The rules say that plans and agents:

  • Must be licensed by the State;
  • May not make unsolicited contacts, including door-to-door sales, cold calls or approaching you in a parking lot;
  • Must have an appointment in advance before coming to your home;
  • Must arrange with you in advance the type of products that will be discussed during a scheduled sales appointment. They may not attempt to sell you other types of insurance coverage other than the type agreed upon in advance;
  • May not try to sell you non-health care related products (like a life insurance policy or an annuity) during a sales or marketing presentation of a Medicare plan;
  • May not attempt to sell you a plan in a doctor’s office or in a pharmacy;
  • May not attempt to sell you a plan at an educational event;
  • May not offer you free meals at promotional or sales events; and
  • May not offer you gifts or other promotional items with a value greater than $15.

Acting Commissioner Kobylowski had additional advice for seniors to assist them in avoiding Medicare fraud.

“As seniors review Medicare coverage options, which can be a challenge in itself, they must also be wary of fraud,” said Acting Commissioner Kobylowski. “Unfortunately there are some bad actors who seek to take advantage of senior citizens during open enrollment. But if seniors review all the information and exercise some basic precautions, they can avoid fraud and chose the insurance product that is best for them.”

The Acting Commissioner offered senior citizens these tips to avoid and combat fraud:

  • Consider your options carefully before making any changes to your Medicare coverage. You should have received a notice from your Medicare Advantage or Medicare prescription drug plan that details the changes in benefits and costs to your plan.
  • Verify that your salesperson and company are licensed. This can be verified through the Department’s website at: https://www16.state.nj.us/DOBI_LicSearch/insSearch.jsp
    For inquiries or complaints, consumers can call either (609)-292-7272 or the Department Consumer Hotline (800)-446-7467.
  • Check that the plan you have chosen is an approved Medicare plan. All plans are listed at www.medicare.gov or available by calling (800)-MEDICARE, (800)-633-4227.
  • Before enrolling in a Medicare drug plan, you should make sure the plan covers the prescriptions you take. Get help using the Plan Finder search tool available at www.medicare.gov to review the Medicare prescription drug benefit and the plans available to you.
  • Before joining a plan, always personally confirm with your doctor and other providers that they will accept the plan.
  • If you are dealing with an unfamiliar agent who has never previously worked with you, be especially cautious. Do not be fooled if a salesperson claims to be with Medicare or Social Security, even if he or she shows you an official-looking identification card.
  • Be careful about giving out your Medicare number or other personal information as this could lead to a consumer being enrolled in a Medicare plan without your knowledge or becoming a victim of identity theft.
  • Do not believe a salesperson or agent who tells you that a Medicare Advantage plan will not affect your original Medicare coverage. If you enroll in a Medicare Advantage plan, it will provide your health coverage instead of original Medicare. Some salespeople may try to tell you that Medicare Advantage plans are Medicare supplement insurance (commonly known as Medigap); however they are not. Medicare supplement plans fill in the “gaps” by paying some of the costs that original Medicare does not pay. Medicare Advantage, however, entirely replaces your original Medicare coverage. Your Medigap policy only works with original Medicare.
  • When meeting with salespeople, ask questions about things you do not understand and take notes. You should write down the salesperson’s name, address, phone number, New Jersey license reference number and anything he or she told you. It is recommended that you have a trusted friend or family member with you when you talk to a salesperson.

If you suspect fraud or abuse, you should contact the Department at 1-800-446-7467 or file a complaint online at: www.dobi.nj.gov 

For more information on Medicare coverage or to get help with a Medicare issue, call the State Health Insurance Assistance Program (SHIP) at 1-800-792-8820 or go online at: http://www.state.nj.us/health/senior/ship.shtml.

“Choosing the proper Medicare coverage and the best provider are very important decisions,” said Acting Commissioner Kobylowski. “We at the Departments of Banking and Insurance and Human Services are dedicated to providing the State’s senior citizens with the resources they need to make the best choices possible.”

 

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