Marketing Medicare Advantage Plans
Before we take a closer look at the do’s and don’ts of Medicare Advantage marketing, please keep in mind these important dates of the Annual Enrollment Period (AEP):
- October 1st – Medicare Advantage (Part C) and Rx (Part D) marketing begins
- October 15th – Medicare Advantage and Rx applications can be submitted for a January 1st effective date
- December 7th – Last day that Medicare Advantage and Rx applications can be submitted for a January 1st effective date.
Why Are There Rules to Marketing Medicare Advantage Plans?
When it comes to Marketing Medicare Advantage Plans there are a lot of do’s and don’ts. The reason is that Medicare and Medicaid Services (CMS) is looking out for the best interest of people on Medicare. Enforcing Marketing rules and regulations allows CMS to ensure that those on Medicare aren’t being harassed, misled, or lied to by agents.
What the Agent Can Do (to Market a Medicare Advantage plan)
Beginning October 1st…
- The agent is permitted to call their own clients to discuss new plan options. If the agent has written a policy for a person, then they are a client, and the agent is free to contact them about new plans that are available for the 2019 year.
- The agent may solicit a potential enrollee who has given previous permission to be contacted. This can happen in a couple of ways. One, the potential enrollee approaches the agent asking to be contacted about a Medicare Advantage Plan. Two, the agent has permission to contact the potential enrollee after a sales event and the person, once again, asks to be contacted.
- The agent may call a potential enrollee to confirm an appointment time. The agent can also call to confirm an appointment with a potential enrollee who lives in a long term care facility on upon request of the potential enrollee.
- The agent can leave business cards with a potential enrollee/client to give to a friend or family member, but the referred person must initiate contact with the agent first.
- The agent can conduct sales activities in common areas of health care facilities. Common areas include hospital or nursing home cafeterias, community or recreation rooms, and conference rooms. Sales activities include submitting an application, or, a sales presentation for a group of people or individual.
- The agent can take an appointment with a potential enrollee immediately after a marketing/sales presentation provided the potential enrollee signs the scope of appointment form prior to the appointment.
About the Scope of Appointment Form
The Scope of Appointment (SOA) form is a required document that gives the agent permission to talk with a potential enrollee about Medicare Advantage or Rx plans. Additionally, the potential enrollee can also elect to discuss other products during the same appointment (i.e. hospital indemnity plans, dental, vision and hearing plans, or Medicare Supplement (Medigap) plans). Make sure to let the potential enrollee know that the SOA is a permission slip for the agent, but they are not required to purchase anything.
Click Here for a generic CMS Approved copy of the SOA form.
What the Agent Cannot Do (To Market a Medicare Advantage plan)
- Agents cannot say they are from Medicare or use the term “Medicare” in a misleading way. They cannot call potential enrollees stating they are representing Medicare or that Medicare asked them to call.
- Agents cannot go door-to-door soliciting potential enrollees. In addition, agents cannot approach people with Medicare in common areas or leave unwanted emails, text messages, or voicemails. If the person is not the agent’s client, they cannot be approached about the subject of Medicare.
- Agents cannot hold sales activities or events within health care settings that are NOT common areas. They are not permitted to meet in waiting rooms, exam rooms, hospital patient rooms, dialysis centers, and pharmacy counter areas.
- Agents cannot make unwanted calls about a non-Medicare related products – such as final expense, annuities, Medicare supplements, etc. – and turn the conversation to Medicare Advantage or Rx products. This is called the “bait and switch” and is not tolerated by CMS.
- Agents cannot call a client that has been referred to them by another client. As stated previously the potential client must make the first contact.
- Agents cannot market non-health related products such as annuities and life insurance to potential enrollees during a Medicare Advantage sale or sales presentation.
- Agents cannot conduct marketing or sales activities at an educational event. For example, they cannot discuss specific plan benefits during an educational event.
- Agents cannot offer gifts to potential enrollees for more than $15. If a gift is offered, it must be available to all potential enrollees, even if they do not enroll in a plan.
What is the difference between a Sales Presentation and an Educational Event?
Sales Presentation/Events are designed to steer or attempt to steer potential enrollees toward a particular plan or limited set of plans. These can in formal or informal group settings – such as being approached by a potential enrollee at a booth. SOA forms are required for one-on-one settings but not during a group presentation.
Educational Events are designed to inform potential enrollees about Medicare Advantage, Prescription Drug (Rx) or other Medicare Programs. During this time, the agent is not permitted to mention a particular plan or products, or, steer the client to purchase a particular plan.
There are a lot of rules for marketing Medicare Advantage and Part D plans. Keep in mind these rules apply only to agents selling Medicare Advantage and Part D plans. If you are selling other health products or non-health products you are not required to comply with CMS’s rules and regulations for Medicare. Finally, we urge you not to see these rules as an inconvenience or burden to selling Medicare Advantage products, rather to understand that CMS’s primary purpose is to protect the interest of the potential client.
Any Questions or Comments?
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