Unbeknownst to eligible Medicare beneficiaries there are numerous rules and regulations governing how insurance companies and their representatives market Medicare Advantage (MA) and Part D Prescription Drug (PDP) plans or the combination of the MA and PD (MA-PD). Even though some of the rules may seem overly restrictive and cumbersome, they have been put in place to protect the Medicare population.
I have tried to outline some of the more important rules involving agents or representatives so you know what to expect when you are gathering information about MA, PDP or MA-PD plans. A comprehensive document on marketing guidance can be found at Centers for Medicare and Medicaid
Scope of Appointment (SOA)
This is a document signed by the Medicare beneficiary and the representative agreeing to discuss only selected topics. Generally, the SOA needs to be completed 48 hours in advance of the appointment and restricts the conversation to MA, PDP or MA-PD plans. With the exception of telephone conversations with the plan sponsor, which are recorded, you should always be asked to sign a SOA.
From CMS guidelines: Marketing appointments are individual appointments designed to steer or, attempt to steer, potential enrollees toward a plan or limited number of plans. All individual appointments between an agent and a beneficiary are considered marketing/sales appointments regardless of the content discussed.
Your meeting with the representative must be focused on the Medicare plans and healthcare related products. The representative, who may be an agent for other insurance lines, can not discuss any other products such as life insurance, annuities, home or auto insurance. The purpose of this rule is to avoid confusing the beneficiary with discussions of other topics. Representatives may not ask you for referrals of your friends and family. They may leave sales material, for all lines, but they are not allowed to talk about.
Virtually all ‘cold calling’ or unsolicited marketing of MA and PD products is prohibited. This includes unsolicited phone calls, emails, text messages or knocking on your door. Direct mail is allowed because you can then contact the company or representative. Door hangers, leaflets and flyers are prohibited. A representative may not approach you and ask about your Medicare eligibility or current plan.
No plans or company material may be present at an educational event. Additionally, there can be no discussion of any MA or PDP benefits or pricing. Educational events are meant to focus on educating the attendees about Medicare and their various options.
A plan sponsor of a MA plan may host an event and discuss their plans. They can offer a gift or prize to all participants as long as the value does not exceed $15. The gifts can not be in the form of cash.
Representative can not say-
- The government wants you to join our plan because it helps them.
- I am certified by Medicare to sell this plan.
- If your doctor accepts Medicare, she accepts this plan.
- There are no limits on services.
- We cover all drugs and have no formulary restrictions.
- If you don’t like this plan, you can stop paying your premium and return to original Medicare anytime.
- It is better to choose a different company if you are sick.
This is just the tip of the ice berg when it comes to marketing MA and PDP products. All representatives must take yearly training and pass tests to confirm their knowledge of the do’s and don’ts of selling MA and PDP products. All of the rules help promote a stress free environment for the Medicare beneficiary to make the right decision for his or her situation.