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.

6 Things You Need To Know About Selling Medicare Supplement Plans

Did you know that more than 10,000 people in the United States turn 65 every day? For insurance agents, that can mean a lot of sales if you get into selling Medicare Supplement Plans. In order to create long-term sustainability for your business, you will need a residual income, and there is no better way to ensure this than by selling Medicare Supplement Plans. If you work hard enough, you could even see a six-figure residual income in as little as three to four years. In order to sell Medicare Supplement Plans, there are 6 things that you absolutely have to know.

illustration of an ambulance
Medicare covers ambulance services, doctor visits, and more.

1. How Medicare Works

In order to completely advocate for a customer, you have to be knowledgeable about the product you are selling. Medicare is divided into 2 parts: Part A (hospital insurance) and Part B (medical insurance). Part B covers essential medical expenses including:

  • Ambulance services
  • Doctor visits
  • Lab tests
  • Cancer screening
  • Diabetes screening
  • Rehabilitation
  • Durable medical equipment

Parts A and B cover 80% of costs after deductibles and coinsurance, and the other 20% is paid by the beneficiary out-of-pocket. However, if they purchase a Medicare Supplement Plan, it will cover that 20%.

Beneficiaries are automatically enrolled in Part A, but they need to sign up for Part B during their Initial Enrollment Period, which includes the 3 months before the month they turn 65, the month they turn 65, and the three months after they turn 65. If they do not sign up for Medicare Part B during this period, they will have to pay a late enrollment penalty of 10% for every year they delayed enrollment. The only way they can avoid this penalty is if they are still insured through an employer’s health insurance plan.

2. Medicare Supplement Open Enrollment

The Initial Enrollment Period mentioned above is also the best time for someone to purchase a Medicare Supplement Plan. Technically, a customer can sign up for a Medicare Supplement Plan whenever they want, but if they do not sign up during their Initial Enrollment, then they will face medical underwriting. They can then end up being denied or charged more due to pre-existing conditions.

3. What Medicare Supplement Plans Cover

bag full of dark red blood laying on a table with tubes
Medicare Supplement Plans help cover some things Medicare does not cover, such as blood transfusions.

Medicare Supplement Plans cover the 20% gap that Original Medicare does not pay for. What’s unique about these plans is that they cover health and wellness benefits that Medicare doesn’t cover at all. This includes:

  • Medicare Part A deductible
  • Part B excess charges
  • Coinsurance and hospital costs for up to one year after Medicare benefits are used up
  • Blood transfusions for up to three pints of blood
  • Hospice care coinsurance or copayment
  • Skilled nursing facility care coinsurance
  • Medical costs incurred while traveling outside of the U.S.

In addition, Medicare Supplement Plans K and L have annual out-of-pocket limits. Once you reach the plan’s limit, Plans K and L cover 100% of covered out-of-pocket expenses for the rest of the year.

4. What Medicare Supplement Plans Do NOT Cover

older asian man looking at a pill bottle in his hand with other bottles sitting on the table in front of him
Unfortunately, there are some things Medicare does not cover, such as prescription drugs.

Although Medicare Supplement Plans cover some services that Medicare does not, that does not mean that these plans cover everything. Medicare Supplement Plans do not cover:

  • Dental care
  • Eye exams
  • Eyeglasses
  • Hearing aids
  • Prescription drugs
  • Long-term care

5. When Medicare Supplement Plans Are Accepted

If a doctor accepts Medicare and Medicare assignment, then they will accept Medicare Supplement Plans as well. They can be used for treatment by any doctor, whether in-network or out-of-network. This makes these plans a great option for people who travel.

6. The Difference Between Plans & How to Switch Plans

There are 10 different Medicare Supplement Plans; the difference between all of them is the coverage that they offer and their price points. A letter identifies each Medicare Supplement Plan: A, B, C, D, F, G, K, L, M, N. Not all states offer all Medicare Supplement Plans, so you’ll have to know what plans are available for customers in your state.

chart of the different medicare supplement plans coverage

***Plans C, Medigap Plan F, and high-deductible Plan F are no longer available to seniors who became eligible for Medicare benefits on or after Jan. 1, 2020.

If your customer already has a Medicare Supplement Plan and wants to switch to a different plan, the only way that they can get the best price is if they pass the set of health questions the insurance company provides. If the customer is within their 6-month Medicare Open Enrollment, or if they have had their current Medicare Supplement Plan for less than 6 months, then they can bypass the underwriting process. If they are not switching within this time frame, then the company can charge them more or deny coverage due to pre-existing conditions.

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