Rules Private Medicare Providers Must Follow

Medicare supplement plans are those offered by private firms on a fee-for-service basis. Depending on the individual plan, certain services are included in the agreement along with the use of particular doctors and medical facilities. The client is given a Medicare plan card they use whenever medical attention is needed in order to determine what is covered by the supplemental plan and what is not. With so many Medicare supplement plan providers in business, it is important that a government sanctioned set of guidelines be adhered to.

To begin, let’s cover what a Medicare supplement plan must make clear to the client. There must be a clear and complete description of how the plan works, in writing. A verbal rundown of the details is not sufficient and not legal. The literature must also make it very clear to the client that there is absolutely no guarantee the doctor or hospital will agree to the plan or provide services. Most doctors and medical facilities are fairly understanding and will accept most plans, but the client needs to know there is no guarantee.

The Centers for Medicare and Medicaid Services demand that every client who has just recently enrolled in a private Medicare supplement plan must receive a phone call from the provider to ensure they really did want to join the plan. This measure is very important as it gives an opportunity for those who may have been confused or coerced into joining a plan, the opportunity to opt out. Additionally, if the private Medicare provider cannot contact the new client via telephone they are required to send instructions via mail on how to disenroll in case there has been a change of heart. The provider must always have qualified people available to answer questions about the plan, as well as questions arising from medical practitioners.

There are a few important things Medicare supplement plan providers are prohibited from doing. Private Medicare supplement plan providers are prohibited from offering cash incentives or providing free meals while marketing the plan to the client. Likewise they are also not permitted to attempt selling a non-health related product such as life insurance, during their discussions about a Medicare plan. Agents can only made an appointment with a prospective client for the purpose of discussing enrollment in a plan, if written permission from the prospect is provided. Likewise, private Medicare plan representatives are also not permitted to visit your home, uninvited, for the purpose of selling additional services or products.

Should a client have questions about their plan, the provider cannot require the caller to speak to a sales agent before obtaining the information and no one is permitted to ask for the client’s personal information of the telephone. Information like a Social Security number, bank account information or credit card numbers should never be given over the phone, let alone to your Medicare plan provider. Payment for your plan is made only via the instructions given on your statement sent through the mail. Similarly, plan providers are not cannot call you unless you are already enrolled, and even then it is only the agent who helped you join who can call. However, if the client requires more services or wishes to enroll a family member, a representative is certainly allowed to visit the home.

If you ever find yourself in a tense medical situation, at a hospital, exam room or pharmacy, and an agent from a Medicare supplement plan provider approaches you, do not engage their services. It is illegal for private Medicare firms to talk about the plans they offer in these situations. The same is true at educational events, fairs and conferences. All agents and brokers of private Medicare plan providers must be state licensed, and the state must be made aware of which agents are selling plans.

As one can see, there are many safeguards in place for the purpose of protecting the people and the medical industry. Some of the outlined rules for providers to follow may seem prohibitive, but they have been created for the purpose of preventing coercive sales techniques, fraudulent practices, identity theft, unfair industry competition and abuse of the Medicare system. As a prospective client, being informed about these guidelines will help you make the right choice in a Medicare supplement plan provider.

Chris Brines is a representative of Medicare Supplement Shop. We compare all Medicare Supplement Plans and prices to make sure you save as much money as possible while still receiving excellent coverage! Check out our latest press regarding our partnership with Rxcut on

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One Response to Rules Private Medicare Providers Must Follow

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