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Reminder about advising patients on Medicare plan enrollment

10/12/2016

The Centers for Medicare & Medicaid Services (CMS) reminds health care providers that they should remain neutral when discussing Medicare and Part D plans with their patients. The Medicare annual election period (AEP) for 2020 starts Oct. 15, 2019 and ends Dec. 7, 2019.

Providers may:

  • Provide the names of plans or plan sponsors with which they may contract and/or participate
  • Answer questions or discuss the merits of a plan or plans, including cost sharing and benefit information
  • Provide information on and help applying for the low-income subsidy (LIS)
  • Refer patients to plan marketing materials that are available in common areas
  • Refer their patients to other sources of information, such as state health insurance assistance programs (SHIPs), plan marketing representatives, state Medicaid offices, local Social Security offices or CMS, either through its website or 1-800-MEDICARE
  • Share information with patients from the CMS website, including the “Medicare and You” handbook, “Medicare Plan Finder” or other resources written or approved by CMS

Providers should not:

  • Offer scope-of-appointment forms for plan sponsors
  • Accept Medicare enrollment applications
  • Mail marketing materials on behalf of plans
  • Make phone calls or direct, urge or attempt to persuade beneficiaries to enroll in a specific plan based on financial or any other interests of the provider
  • Offer anything of value to induce plan enrollees to select them as their provider
  • Offer inducements to persuade beneficiaries to enroll in a particular plan
  • Conduct health screenings as a marketing activity
  • Accept compensation directly or indirectly from a plan for beneficiary enrollment activities
  • Distribute materials or applications within an exam room

Providers who violate these regulations could face penalties up to and including termination of their contract with Medicare and Part D plans and plan sponsors.

If you have questions about discussing Medicare enrollment with your patients, please contact your network account manager.