What Private Information Will My Medicare Agent Request?


Elderly adults are scammed out of approximately $2.9 billion each year, according to the Senate Special Committee on Aging. Scammers use advanced, persuasive techniques to lure even the savviest, educated and cognitively intact seniors into turning over personal information—either over the phone, via email or in person—so they can use it to steal your identity and commit fraud.

Medicare takes your privacy and security very seriously. Plan agents, those independent brokers who are licensed to give you an unbiased opinion on your Medicare plan options, must adhere to strict compliance guidelines before, during and after they meet with you to discuss the plan options available in your area.

First things first, be aware that a person representing Medicare plans cannot come to your house or meet you elsewhere if you have not invited them to do so. They will never ask for your personal information, including your Medicare, Social Security, bank account or credit card numbers over the phone unless it is needed to verify your membership, enrollment eligibility or process and enrollment request.

During your meeting, agents are allowed to give you plan and educational materials and the plan’s enrollment kit. They can discuss different plan options, tell where you can find additional information (like a website), and provide and collect completed enrollment forms, and leave business cards for you to give to friends and family. The plan carrier will follow up to verify that you want to join the plan. The agent who helped you can call you afterwards to talk about other plan options. The agent will not ask you for payment. You will receive information about confirming your payment choice after your application is accepted.  

When you fill out a Medicare enrollment form, you can expect to fill in certain details, including the following:

  • First, middle initial and last name
  • Gender
  • Date of birth
  • Medicare number
  • Hospital coverage start and end dates
  • Permanent address
  • Phone
  • Email (optional)
  • Emergency contact name, phone and relationship to you
  • Alternative accessible format (i.e. screen reader PDF, audio CD, braille, large print
  • Preferred language for customer service
  • Additional prescription drug coverage – yes or no
  • Work status of applicant and spouse – yes or no
  • Additional health coverage outside of Medicare – yes or no
  • Social Security Number
  • Driver’s license number
  • State ID card number
  • Credit or debit card and bank account numbers.

HIPAA, or the Health Insurance Portability and Accountability Act dictates the use and sharing of PHI and PII and how PHI should be maintained, used, transmitted and disclosed electronically. Keep in mind, PHI and PII can be oral, written, or electronic.   

Plan agents have an obligation to safely and securely protect their client’s personal health information (PHI) and personal identifying information (PII). When you apply for coverage and/or enroll in a plan, that is considered your personal health information. PHI includes:

Here are some ways you can protect yourself from Medicare fraud:

Medicare fraud can occur if your Medicare card is stolen or compromised.

  • Never give anyone your Medicare number or other personal information unless you contact them or give them permission to contact you in advance.
  • Never give anyone your Medicare number in exchange for promises of gifts or other things of value. 
  • Never allow someone to enroll you in a Medicare plan over the phone unless you called first.

To help prevent Medicare fraud, report suspicious activity or behavior to Medicare and check your Medicare billing statements frequently to make sure the claims and summary notices are for services you received.

Walsh Duffield is here to help.

If you have questions or concerns about the safety and security of your personal health information, speak with our specialists who can put your mind at ease. Find your plan today.

The above description provides a brief overview of the term and phrases used within the insurance industry. These definitions are not applicable in all states or for all insurance and financial products. This is not an insurance contract. Other terms, conditions and exclusions apply. Please read your official policy or full details about coverage. These definitions do not alter or modify the terms of any insurance contract. If there is any conflict between these definitions and the provisions of the applicable insurance policy, the terms of the policy control.