What Agents Need to Know About Medicare Compliance

Sarah Jacobson

To ensure that seniors are provided with transparent and up-to-date information about their insurance options, Centers for Medicare and Medicaid Services (CMS) have Medicare marketing guidelines for agents to follow. The goal of these compliance rules are to protect seniors before, during, and after they enroll in a plan.

We interviewed Ann McGlamery, Director of Compliance Oversight and Development Berwick Insurance Group, to learn more. She gave 5 key compliance components for independent Medicare agents to consider when working with seniors.

Follow Medicare marketing guidelines

When agents are creating resources such as flyers, emails, and presentations, they first need to distinguish between marketing and communications materials.

The intent of a marketing material is to draw attention to a specific carrier, plan, or plan benefit. This could include star ratings, monthly premium, fitness memberships, or other factors that may persuade a client to stay on their current plan or move to another. In contrast, communications materials provide more general Medicare information without mentioning specific carriers or plans.

Seniors sift through piles of information about Medicare, and constantly need to distinguish official Medicare letters from marketing. Because of this, you should make it clear that your material is from a licensed agent by including your name, agency, contact information, and business logo.

All materials should avoid misleading approaches

●     Do not make it seem like the material is coming from Medicare.

●     Do not use misleading information such as barcodes or ID numbers that mimic official government letters.

●     Do not use scare tactics or verbiage that implies something bad will happen if the consumer does not act now.  

If the material includes carrier names or plan-specific details, there are additional steps that the agent must take per the Medicare marketing guidelines. For marketing materials, agents must get expressed written permission from the mentioned carriers and file it with CMS to get a unique identifier.

Many carrier portals have pre-approved marketing materials for quick and easy agent use. Agents should make sure that they are using the materials for their intended purpose, and not altering them in any unauthorized way. When creating materials themselves, agents should seek help from their FMO to ensure that they are following the guidelines correctly. Ann advocates that agents should not be afraid to ask questions about compliance.

“We want to help foster understanding of these regulations and help agents stay on top of the ever changing landscape.If an agent calls with a question, we really are here to help.” - Ann McGlamery

Get permission to contact

Another important compliance rule for Medicare agents is to obtain permission to contact. Agents cannot cold call, text, or email a client without express permission to do so. Many agents send business reply cards to prospects to get permission to contact. If you use this method, be sure to include who will be conducting the outreach, how they will conduct outreach, and which products they’ll be talking about.

If the client includes their mailing address, the agent does not have permission to show up on their doorstep. Always remember to prioritize the safety and privacy of the prospect.

Sign a Scope of Appointment

A Scope of Appointment is a document in which clients indicate what Medicare products they are interested in talking about. For general advice, such as when to sign up for Medicare or how to complete the Part B application, you do not need to sign a Scope of Appointment. However, your client does need to complete one before you can discuss specific plan details and benefits. This rule applies to Medicare Advantage plans and prescription drug plans.

Agents do not need to use a carrier-specific SOA, but they must keep them on record for 10 years. You can use a paper Scope of Appointment or send one through a carrier portal or third party enrollment system.

Record phone and video calls

In 2022, CMS implemented a new rule for Third Party Marketing Organizations (TMPOs), which includes independent agents. This rule requires agents to record all phone and video conversations with Medicare clients before, during, and after enrollment. Similar to the Scope of Appointment, agents are required to keep the recordings on file for 10 years. Many agents use a recording service that integrates with their CRM for secure and efficient storage.

Protect your client’s privacy

Medicare agents handle a lot of protected health information (PHI) and personally identifiable information (PII) for their clients. When it comes to client data, agents need to be sure that they are protecting the information in a secure way. To store data securely, follow the procedures below.

●     Use a full disk encryption program on your computer. Ann suggests having documentation of this measure on a different device. This will act as evidence that the data is secure if your computer gets lost or stolen.

●     Use an encryption program if you are communicating PHI or PII via email.

●     Keep hard copy documents in a locked filing cabinet.

●     Conduct client meetings in a place where your conversation can’t be overheard.

Resources for compliance & Medicare marketing guidelines

It is important for agents to stay up-to-date on compliance. Ann gives a few recommendations for agents when it comes to compliance:

●     Familiarize yourself with carrier portals to find approved marketing materials.

●     Subscribe to the CMS newsroom and the Federal Register Daily Journal to stay informed on changes that may be happening.

●     Create an inbox folder for all your carrier updates. Important changes often look the same as smaller updates, so it’s important to set aside time each week to read them.

By staying up-to-date on compliance, agents can ensure that they are following all of the necessary regulations and policies to protect their clients. If you have any questions regarding compliance, reach out to your FMO for assistance. Agents have a lot of responsibilities to juggle, but your FMO can help you with compliance so that you can focus on growth.

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