Do’s and Don’ts Of Medicare Compliance

Before you can begin selling Medicare, you must first get your license to sell Medicare products, followed by certifications from carriers to sell Medicare Supplement Plans. But after all that, there is still one more thing to be aware of before you’re ready to sell. You need to know how to remain compliant with all the rules surrounding Medicare sales. In order to show your commitment to honesty and integrity, as well as to fulfill your legal duty and contractual obligations to sell Medicare, you have to be compliant with the following rules in all of your interactions with customers. Here are some simple do’s and don’ts to help you stay in compliance.

Medicare Compliance For Selling

When Selling Medicare:

DO:

caucasian man with a white button up sitting down filling out a form
Before contacting a lead, make sure to fill out a Scope of Appointment.
  • Make sure that you have Permission To Contact the prospect. Agents are not allowed to make unsolicited phone calls or send emails to prospects without having an opt-out option. In order to obtain permission to contact, you must use a lead provider like Benepath, who will have prospects/leads sign a form that says they agree to be contacted by an agent.
  • Complete a Scope Of Appointment form before each face-to-face appointment and/or one-on-one phone conversation. These forms outline exactly what you’ll be talking about with your client during a meeting. Per CMS, you must keep these forms on file for at least 10 years, even if your conversation did not end in a sale.
  • Report any suspected violations to the Medicare Compliance Hotline toll-free at 1-877-211-2290.

DON’T:

  • Engage in door-to-door marketing or sales
  • Use high pressure sales tactics
  • Engage in outbound telemarketing or email campaigns
  • Discuss with prospects any products that are not specified in their Scope of Appointment form
  • Engage in any discriminatory activities, such as conditional enrollment based on a prospect’s mental illness, physical illness, or disability

Medicare Compliance For Marketing

CMS also has regulations in place for marketing, educational events and sales event presentations.

DO:

illustration of a man in a suit talking to a group of people sitting down.
When marketing, you can distribute educational materials at an event that are not plan-specific as well as your business cards.
  • Wait until October 1 to begin marketing next year’s plans to potential customers
  • Distribute educational materials that are free of plan-specific information
  • Give out your business card and contact info
  • Collect Scope of Appointment forms
  • Hold your event in a public venue

DON’T:

  • Attempt to mislead your clients, willingly or unwillingly
  • Use the word free to describe $0 premiums
  • Serve meals at sales events
  • Pressure attendees at events to complete a sign in, it must be optional
  • Distribute plan-specific materials at an educational event (only do this at sales events)
  • Discuss any carrier-specific plans or benefits at educational events (only do this at sales events)
  • Cross-sell or promote health-related products at events

It is important that you follow these rules for Medicare compliance set by CMS, or you risk violations, and you may lose your ability to sell Medicare if you are reported. If you are looking for leads that have given permission to contact, Benepath will provide these leads exclusively to you. We give you exclusive real-time leads when you want them. To find out more information, call 866-368-0377.

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