Medicare Open Enrollment: Red Flags to Watch Out For
Medicare’s Annual Enrollment Period (October 15 – December 7) is the busiest time of the year for insurance decisions. Unfortunately, it’s also the time when some agents bend or break the rules. Knowing the red flags can help you protect yourself and make confident choices.
🚫 Common Illegal or Unethical Practices
Cold Calling
Agents are not allowed to call you out of the blue about Medicare Advantage or Part D plans unless you’ve given them permission.¹
This isn’t just something you hear about from foreign call centers — sometimes these calls come from people right in your own community.
Bad-Mouthing Other Agents or Plans
No agent should pressure you by putting down another agent, company, or plan.²
You deserve clear, unbiased information so you can choose what’s best for you.
Steering for Higher Commissions
Some agents push plans that pay them more, even if the plan isn’t right for you.³
A good agent’s job is to present all available options and explain how each one works.
Unsolicited Door Knocking
Agents can’t show up at your door without a prior appointment.⁴ If they do, you have every right to turn them away.
Pressure Tactics
“You need to sign up today or you’ll lose coverage” — statements like this are scare tactics and are not allowed.⁵ You should always be given time to review your options.
✅ Your Rights as a Medicare Beneficiary
You have the right to choose your own agent or broker.
You have the right to see all plan options available in your area, not just the ones that benefit the agent.
You have the right to say no to phone calls, door knocks, or pushy sales pitches.
You have the right to report misconduct to protect yourself and others.
📢 Where to Report Problems
Insurance Company (Carrier): Fastest route; compliance teams can act quickly.
Medicare (1-800-MEDICARE / 1-800-633-4227): Creates an official record with CMS.
Wisconsin SHIP: Free, unbiased counseling; can guide you through the complaint process.
Wisconsin Office of the Commissioner of Insurance (OCI): Regulates licensed agents; can investigate and take disciplinary action, including fines or license suspension.⁶
When reporting, include:
The agent’s name
The company they represent
The date and details of what happened
✔️ The Bottom Line
Medicare rules exist to protect you. If someone is breaking the rules — cold calling, bad-mouthing, pressuring, or steering you — that’s a red flag. And remember, it doesn’t just happen from a random call center far away — it can happen right here in small communities, too.
Trustworthy agents put your needs first, not their commissions.
📚 Legal References
Cold Calling: 42 C.F.R. § 422.2264(c)(1); CMS Agent/Broker Dos & Don’ts (Sept. 2021).
Bad-Mouthing / Misrepresentation: 42 C.F.R. § 422.2262(a); Medicare.gov, Plan Marketing Rules.
Steering / Biased Recommendations: 42 C.F.R. § 422.2262(a)(1); CMS Medicare Communications and Marketing Guidelines (MCMG).
Unsolicited Door Knocking: 42 C.F.R. § 422.2264(c)(3); CMS Agent/Broker Dos & Don’ts.
Pressure / Scare Tactics: 42 C.F.R. § 422.2262(a)(2); CMS MCMG prohibiting coercive or misleading sales practices.
Wisconsin Oversight: Wis. Stat. § 628.34 (unfair marketing practices); Wis. Admin. Code Ins 20.01 (home solicitation selling); Wisconsin OCI Complaint Process (oci.wi.gov).
