Unsolicited Calls About Medicare? Just Hang Up!

There is no shortage of agents in the Medicare business who will compromise morals, ethics, and integrity in exchange for a quick plan enrollment and commission payout. Many of them are employed by Medicare call centers that focus on Medicare populations that have special election periods (SEPs) that are available year-round. (A valid election period is required for an agent to switch you from one Medicare Advantage plan to another.) Two examples:

• Dual-Eligible Medicare beneficiaries: These are Medicare beneficiaries that also have Medicaid (State assistance for low-income/low-asset individuals). Depending on their level of Medicaid, some dual-eligible Medicare beneficiaries have an SEP that allows them to change their Dual-Eligible Special Needs Plan (DSNP) once a month.

• Chronics: These are Medicare beneficiaries with chronic conditions: diabetes, COPD, emphysema, and certain cardiac conditions, among others. Chronics have an SEP that allows them to switch to a Chronic Special Needs Plan (CSNP) once in the calendar year.

It's the SEPs that are available year-round that put a target on the backs of these groups and make them prime fodder for Medicare call centers. These call centers buy lists of people who are on Medicare and who are also either dual-eligible or who have chronic conditions. And from there, it's just about dialing for dollars. These calls are outbound from the call center to you, unsolicited, meaning they are calling you directly when you did not request to be contacted.

Case Studies from My Own Clients

Call center agents get paid only for one thing: a plan change. To get you to agree to the plan change, they dangle a shiny object in front of you, meaning they will highlight a certain feature of the plan they are proposing, and that's all they will focus on. What they will not do is carefully review all aspects of the plan change to see if it is a suitable fit for your overall medical and financial needs. Here are a couple of examples of what happened to some of my own clients when they decided to engage with an unsolicited call about their Medicare coverage.

Case Study: Dual-Eligible Special Needs. Client (let's call him Mr A) received an unsolicited call from an agent telling Mr A that they were calling from his Medicare plan carrier. (They were not.) The agent told Mr A that he was in an HMO and could easily benefit by moving to a PPO that did not require referrals to see specialists. (The shiny object.) Mr A agreed to the plan change. Result? To begin with, the HMO in which Mr A was already enrolled was an open-access HMO, meaning that Mr A DID NOT require referrals to see a specialist to begin with. The new plan reduced Mr A's combined food/OTC/utility allowance from $357/month to $300/month, costing Mr A $342 in allowances over the rest of the plan year. But all Mr A heard was "no referrals", the shiny object the call center agent dangled in front of him. The call center agent got their commission, of course.

Case Study: Chronic. Client (let's call her Ms B) received an unsolicited call from an agent offering to review the Ms B's Medicare plan to see if she was getting "all the benefits she deserved". Ms B agreed. The call center agent already knew that Ms B was diabetic and immediately steered her to a CSNP so the chronic SEP could be used for the enrollment. The agent told Ms B that because she was diabetic, she qualified to enroll in a CSNP that would rebate $151/month toward her $185/month Part B premiums. (The shiny object.) The result? Ms B agreed to plan change. The agent failed to explain, however, that the CSNP would increase Ms B's co-pays for most medical services, double her maximum out-of-pocket financial exposure and triple the cost of her drugs over the rest of the plan year. But all Ms B heard was "$151 more per month in my Social Security deposit", the shiny object the call center agent dangled in front of her. The call center agent got their commission, of course.

Don't Take the Bait!

Here are a few tips to avoid being manipulated by unscrupulous call center agents:

1. If you get an unsolicited call about Medicare, HANG UP! You should never answer unsolicited calls from Medicare call centers. If you do answer unawares, hang up right away. These people do not have your best interests in mind.

2. Don't call 1-800-ANYTHING! Call a trusted, licensed, knowledgeable, responsive independent agent. If you don't already have such an agent, call me.

3. Never give out personal information over the phone to an unsolicited caller. That includes your Medicare number!

4. Don't provide your contact information online. If you do, your phone won't stop ringing, ever!

If You've Been Switched to an Unsuitable Plan

If you've been switched to an unsuitable plan because of an unsolicited call about your Medicare coverage, feel free to contact me here and let's see what we can do to get you on a plan that works for you.