Marci's Medicare Answers: Medicare Advantage plans are regulated

Dear Marci,
I have received mail lately about different Medicare Advantage plans. Do Medicare Advantage plans have to follow any rules when marketing their plans to me? —James

Dear James,
Yes, there are specific guidelines that companies selling Medicare Advantage plans and Medicare Part D plans must follow when promoting their plans to you. These guidelines are meant to prevent marketing fraud, or deception about what a plan offers and how much it costs.
Companies are allowed to market their plans through direct mailings and television, radio, and print advertisements.
However, plans are not allowed to:
Call you if you did not ask them to do so;
Send you unsolicited e-mails. You must have specifically requested information in order for a plan to e-mail you;
Visit you in your home or nursing home without an invitation. You can ask the plan to send someone to your house, but they cannot just knock on your door uninvited;
Ask for your financial or personal information if they call you. Beware if you are asked for your Social Security or Medicare number or your bank information;
Provide gifts or prizes worth more than $15 to encourage you to enroll;
Disregard the National Do-Not-Call Registry and do not call again requests;
Market their plans at educational events, in health care settings or at locations and events where free meals are provided;
Sell you life insurance or other non-health related products at the same appointment. This is called cross selling and it is prohibited unless you request the non-health related product information;
Compare their plan to another plan by name in advertising materials;
Include the term Medicare Endorsed or suggest that it is a preferred Medicare drug plan. Plans can use Medicare in their names as long as it follows the plan name (for example, the Acme Medicare Plan) and the usage does not suggest Medicare endorses that particular plan above any other Medicare plan;
Imply that they are calling on behalf of Medicare. Plans are not allowed to give you the impression that Medicare asked them to call you.
To report fraud you should either contact 1-800-MEDICARE (800-633-4227) or the Inspector General’s fraud hotline at 1-800-HHS-TIPS (800-447-8477).When Medicare investigates the potential fraud, your name will not be used if you do not want it to. —Marci

Dear Marci,
I live in New York but will be visiting family in California this month. Will Medicare cover the costs if I need to visit a doctor while I am there? —Christina

Dear Christina,
This depends on how you receive your Medicare benefits. If you have Original Medicare, the traditional Medicare program administered directly through the federal government, you can travel anywhere in the United States and its territories and get medical care from almost any doctor or hospital. This includes all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
In order for medical services to be covered by Medicare, make sure that you see a participating doctor who accepts Medicare and will take Medicare assignment. A doctor who takes Medicare assignment agrees to accept the Medicare-approved amount as full payment.
If you have a Medicare Advantage plan, your plan may not cover your care while you travel in the United States unless you need emergency or urgent care. If your plan does allow you to see providers that are outside of your network or area, you will usually need to pay more for the care, except for emergency or urgent care. You may also need to follow other plan rules like obtaining prior authorization. Contact your plan to see what rules and costs apply when you travel within the United States. —Marci

Dear Marci,
I think my monthly income is a little over the income limit for a Medicare Savings Program. Should I still apply anyway? —Alexander

Dear Alexander,
Yes, even if your income is above the guidelines for a Medicare Savings Program, you should still apply. You may still qualify for an MSP because certain income and assets may not count.
Each state has its own formula for counting your income and assets to determine eligibility for an MSP.
In all states, the following income is never counted:
—The first $20 of all income.
—The first $65 of monthly wages.
—One-half of your monthly wages (after the $65 is deducted).
—Food stamps.
Some states may not count other income, and/or may exclude things from your income, such as the money you use to pay health insurance premiums (like Part B premiums). Also, if there are more than two people in your household, the monthly income limit may be higher in some states.
In all states, the following assets are never counted:
—Your primary house.
—Your car.
—Household goods and wedding/engagement rings.
—Burial funds for you and your spouse valued up to $1,500 each.
—Life insurance with a cash value of less than $1,500.
Many states do not count other types of assets. Some states have no asset test.
To find out your state’s guidelines for determining eligibility for an MSP, contact your local State Health Insurance Assistance Program. To find the contact information for your SHIP, you can go online and visit www.shiptalk.org. —Marci