Help Patients Avoid Medicare Advantage Fraud

Your Medicare patients can enroll in Medicare Advantage (MA) plans for the coming year until Dec. 31, and they may ask you about possible changes in their Medicare coverage. The Texas Department of Insurance (TDI) says that patients need to know that some plans may not be right for them, and more important, they need to be wary of deceptive and fraudulent Medicare sales practices.

Here are some TDI tips you can give your patients:

  • Their choice of physicians and other health care professionals in an MA plan may be restricted. Before joining a plan, patients should always personally confirm with their physicians and others that they will accept the plan. They should not take a salesperson's word for it.
  • Patients should not buy anything from a salesperson who comes to their home uninvited. It is illegal to sell MA plans door to door. Plans may market by direct mail and by telephone, but they must comply with the "Do Not Call" registry.
  • Don't be fooled if a salesperson claims to be with Medicare or Social Security, even if he or she shows an official-looking identification card. Medicare and Social Security do not make home visits or unsolicited phone calls. An agent may not enroll patients in an MA plan over the phone unless the patient made the call.
  • Patients must be careful about giving out their Medicare number or other personal information. An unethical salesperson can use this information to remove them from original Medicare and enroll them in an MA plan without their knowledge. Patients should not sign anything they haven't read and don't fully understand.
  • Don't believe a salesperson or agent who says an MA plan won't affect their original Medicare coverage. If they enroll in an MA plan, it will provide their health coverage instead of original Medicare. Some salespeople may try to tell patients that MA plans are Medicare supplemental insurance (commonly known as Medigap). They are not. Medicare supplemental insurance fills in the "gaps" in original Medicare by paying some of the costs that original Medicare won't pay. Medicare Advantage, however, entirely replaces their original Medicare coverage as well as any Medigap policy they might have.
  • Take their time to decide. Patients should not buy anything from a salesperson who tries to pressure them into making a quick decision.
  • When meeting with salespeople, patients should ask questions about things they don't understand. Take notes. Write down the salesperson's name, address, telephone number, and anything he or she told them. It's a good idea to have a trusted friend or family member with them when talking to the salesperson.
  • Patients should verify that an agent and company are licensed. Selling insurance in Texas without a license is illegal. Patients can visit the TDI Web site at or call TDI's Consumer Help Line at (800) 252-3439 to verify a license.

Enrollment for the Medicare prescription drug benefit also ends Dec. 31. Before enrolling in a Medicare drug plan, patients should call their pharmacy to make sure the plan covers their prescriptions. More information about Medicare Advantage plans and the Medicare prescription drug plan is available at or by calling the Medicare Help Line at (800) 633-4227.



Action , Nov. 15, 2007

Last Updated On

May 13, 2016

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