It’s that time of year again


If you or someone for whom you care is on Medicare, it is that time once again when we enter the annual enrollment period. If you are currently much younger and therefore not on Medicare, or you are not contemplating becoming Medicare eligible in the near future, or caring for someone who is or will soon be on Medicare, then the column this month is probably not for you. Of course, last month, the column was targeted for the younger set, those going or anticipating going to college.

Oct. 15-Dec. 7, is the Medicare Annual Enrollment Period (AEP), a timeframe when those on Medicare are eligible to change their Medicare Advantage Plan or other Medicare Supplemental Plan to another provider plan.

Of course, there are exceptions whereby certain circumstances allow one to make changes at times other than during the AEP but these are too numerous to go into here. One exception that I will mention is one’s initial enrollment period. I mention the exception here because many people are unaware of this important timeframe and if they miss it, they must wait until the next AEP to enroll.

If you are turning 65, you are eligible to enroll during a seven-month timeframe, beginning 3 months prior to your birth month, your birth month, and 3 months following. One important exception is IF you are born on the first day of the month, your eligibility period runs from 4 months prior to your birth month until 2 months following. If you are turning 65, don’t miss this important enrollment timeframe.Now, onto other important matters around the AEP. Given the fact that companies can afford to hire big name ex-football players and ex-comedy TV stars whose commercials play incessantly whenever your TV is turned on, indicates that there is a lot of money at stake here. Note that these ex-stars are not providing these ads because they care about your health, they are doing it for the money paid to them. They are working for a company and once you call that 800 number, you are basically at the mercy of that company’s representative who answers your call.

However, there is nothing illegal or fraudulent with regard to what those advertisers are doing. Irritating maybe, but not fraudulent nor illegal. On the other hand, there are fraudulent or otherwise improper practices that always pick up steam this time of year and that is the direct phone call or other direct solicitation. In past years, it was in violation of Medicare rules to solicit a person directly via email. However, evidently, that rule was changed this year. E-mails may be sent unsolicited to Medicare beneficiaries. However, they must include an opt-out feature and does not grant permission for other direct contact. In every case, no matter the type of advertising, the Medicare beneficiary has to proactively reach out to the advertiser and must initiate the personal contact to be legal viaMedicare rules. Also, advertisements of any type must now clearly indicate that the responder will be connected to a licensed agent. In addition, note that now all telephone conversations by an agent (or agent’s representative) with a Medicare beneficiary must be recorded.

That recording must besaved for 10 years.If the Medicare beneficiary does not wish to be recorded, the agent must end the call. Face to face, in-person meetings, do not have to be recorded.Be aware, however, that direct solicitations like all those phone calls you receive trying toconvince you that they are calling to ensure that you are “getting all the benefits you deserve” are illegal by Medicare rules. How do they get by with it? The rules are just not enforced as noted below. A couple of times in the past, I let one of those illegal calls go through to the “licensed agent.” During one of the calls, I asked the agent how the company got away with such illegal activity. She informed me that when the caller asked if it would be okay to transfer me to a licensed agent, and I said “yes,” that was my consent and alleviated her company from any legal liabilities.

When I pointed out that it was their representative that initiated the call, she merely repeated the phrase that when I said, “yes,” I was giving my authorization to speak to the company licensed agent. In other words, the insurance company behind the calls has hired an independent third-party call-center to initiate the calls, thereby making it seem as if they had nothing to do with initiating the calls and is therefore not culpable. In this case, a major reason this continues is that no one is enforcing the law, thus allowing the practice to continue. Of course, the ploy when you receive one of those calls is that they “want to make sure you are receiving all the benefits you deserve,” especially any “additional benefits you may not be getting now.” If you respond that you already have an agent that provides that service for you,they will reply that it still never hurts to get a second party opinion to ensure you are getting all the “benefits you deserve.”

Another time, I continued the call to see what the licensed agent would recommend. Naturally, she was employed by a different provider from my current one, so she found an item that her provider had in their plan that my provider did not have. However, when I checked to see if my primary care physician or other medical specialists were covered by her company’s plans, they were not — but she assured me that she could assist me in finding otherdoctors and medical providers that were in their plan. Thank you very much!

My advice is that you locate a competent agent that specializes in Medicare services and work with him or her. Stay with them each year unless there is a real need to switch to another agent. Rule #1: Be very cautious about paying for assistance with Medicare enrollments. Licensed insurance agents are compensated via commissions paid to them by the companies theyrepresent and thus are prohibited from charging you a fee directly. If you ask a licensed agent theamount of his commission, he is obligated to tell you. On the other hand, unlicensed consultants are not prohibited from charging you a fee for advising you regarding enrollment. The agents on the calls, whether initiated by you or them, are compensated via commissions from the companies with whom they work.

Remember, those who call you, or those to whom you talk when you “call the toll-free number on your screen,” are working for a specific insurance provider. On the other hand, your independent agent will most likely representseveral providers such that he or she can conduct an honest and detailed comparison between providers in order to find the one that is best for you and your health circumstances. A good agent will often help with issues for which he is not compensated in order to earn your continuedbusiness in those areas for which he is paid a commission. A major advantage to working with a good local agent is that he or she will be there when you need them during the year while those on the calls, whether they initiated the call or you did, or an unlicensed consultant, will be there for you only as long as it takes to get you enrolled in their program. There is one problem with finding a good licensed insurance agent. There is no registry tohelp you find one and, and unlike the unlicensed consultant, they are prohibited from direct solicitation and other forms of initiating contact. There is a state registry of all licensed agents but it is just a list and does not provide you with information regarding their specialties. The best way to locate a licensed agent is by word-of-mouth from friends, family, and trusted acquaintances.

News flash! If you are unable to locate a good licensed agent specializing in Medicare insurance, there is now a newly released reasonable alternative. For the past 30 years there has been an organization called the Ohio Senior Health Insurance Information Program (OSHIIP), the state’s official Medicare educational resource, funded in part by Medicare. Until now, they basically provided educational seminars that one could attend free of charge although they provided no other substantial assistance. That all changed on Sept. 23.

“Our OSHIIP Medicare experts are ready to be of assistance every step of the way,” OhioDepartment of Insurance director Judith L. French said. According to the announcement, by attending an OSHIIP sponsored Medicare Check-up event, “experts will go over Medicare fundamentals, what’s new, how to review current plan and compare plans for 2023, prescription drug coverage options, and ways to save money. The events are presentation-only until Oct. 15 when plan comparisons and counseling services become included in most events.” “To find an event in or near your community, an on-site schedule, which can be sorted by date and county, is available at, where you can also find a listing of virtual events which will be recorded for online viewing.” However, note that once the seminar event is over, so is their assistance, unlike a good local agent.

As I close, I leave you with this one potential fraudulent practice. When you deal with an agent on a call, whether initiated by you or them, there have been cases whereby the Medicare beneficiary ends up getting switched to another Medicare provider without realizing that was happening when he or she said, “yes.” While this kind of deceptive practice was the reason for the requirement that all calls be recorded and the recordings retained for ten years, that does not mean unscrupulous companies will be deterred

By Don Shrader

Guest Columnist

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