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Business TipsMedicare

Making Sense of Medicare Compliance Rules

By September 28, 2020January 27th, 2024No Comments

Compliance is a critical part of selling Medicare products to clients. We want to ensure that our agents have the necessary tools to sell effectively, while also making sure our agents are protected. Want to stay compliant with CMS marketing guidelines? We’re here to help. Here’s a list of things agents should never say to prospective, or current, clients.

“I am endorsed by Medicare!”
Agents should never claim to work for Medicare or be endorsed by Medicare or CMS in any way.

“Are you interested in free premiums?”
CMS guidelines dictate that agents should never use the term “free” to describe a $0 premium, or in conjunction with any reduction in premiums, deductibles, or cost share, including Part B premium buy-down, low-income subsidy or dual eligibility.

“I really think this plan is the best option for you.”
Though you may be tempted, CMS dictates that agents should never refer to any specific plan as “best.” Agents should never pressure a client to join a specific plan. Stay away from using superlatives to describe Medicare plans and benefits. The agent cannot show favoritism between carriers or plans.

“Since you decided on a Medicare plan, let’s go ahead and talk about annuities!”
Under CMS guidelines, agents are not permitted to cross-sell non-health-related products during a Medicare Advantage or Part D sale. Anything that is not a health-related product, such as life insurance policies or annuities, cannot be cross-sold during a Medicare sale. Before talking about these products, the agent should end the Medicare appointment.

“I’m offering a gift to all new plan enrollees during this enrollment period.”
Agents are not allowed to offer incentives for joining plans – ever! Plans/Part D Sponsors may offer gifts to potential enrollees, as long as those gifts are of nominal value, and are provided regardless of enrollment, and without discrimination. However, incentives and rewards may be okay for current enrollees. For more information, refer to CMS’ Medicare Communications and Marketing Guidelines, section 70.1 and 70.2.

“While you’re waiting for your prescription to be filled, let me talk to you about your Medicare options!”
Insurance agents and plan sponsors are not allowed to conduct sales and marketing activities where beneficiaries receive their health care services – such as waiting rooms, pharmacies or treatment centers.

“Please make sure you sign in at my event.”
Sign-ins at any event must be optional. Not only that, but the sign-in sheet is required to clearly indicate that sign-ins are not required.

“I’m trying to grow my network of clients. Would you mind sharing with me your friend’s phone number?”
While agents are allowed to ask for referrals, they can only ask for a contact’s name and mailing address – not a phone number.

By working with a full-service insurance FMO like Carolina Senior Marketing in North Carolina, you will have a partner with the attention to detail for compliance in your marketing and communications practices.