Medicare Compliance 101: What Not to Say in Medicare Sales

Nov 7, 2016

Happy Medicare AEP! We’re here with some cheery CMS compliance reminders. It’s back to basics with Medicare Compliance 101 — starting with what not to say in Medicare sales.

The Don’ts of Medicare Sales Compliance

Here are 10 things to never say to stay CMS compliant:

  1. “Free premiums!”
    You want to avoid the word “free” (section 40.4, page 17). $0 premiums and copays usually pertain to specific areas. Never generalize a plan. The last thing you want to do is mislead the beneficiary.
  2. “I’m looking for more referrals. Can I get your friend’s phone number?”
    It’s okay to ask for referrals, but only for their names and mailing addresses (Section 30.8, page 10).
  3. “This plan is the best.”
    Never refer to any plan as “best”. You can’t push or pressure a beneficiary to join a specific plan. See section 40.4 on page 17 for more info.
  4. “If you like this plan, you should hear about this life insurance plan.”
    An agent can’t cross-sell insurance products or sell non-health related products to their Medicare clients.
  5. “We’re offering gifts for new plan enrollees!”
    No incentives for joining plans, period. Refer to CMS guidelines section 70.1.1 (page 42) on Nominal Gifts for more information.Note that incentives and rewards may be okay for current enrollees. (See section 70.2 on page 43 for more details).
  6. “I’m endorsed by Medicare.”
    You can never claim to work for Medicare or be endorsed by Medicare/CMS in any way. This should be made clear to the beneficiary. Refer to section 40.4 on page 16.
  7. “Come to my event for a free meal.”
    You can never offer meals during your sales and marketing events. Light snacks are okay. See section 70.3 on page 43 for more on meals.
  8. “You have to sign in at my event.”
    Sign-ins at events must be optional. In fact, your sign-in sheet must clearly that sign-ins are not required. (See page 51 from section 70.9).
  9. “Let me get your contact info so you can come to my event.”
    You cannot require potential clients or people interested in your event to provide any contact information in order to attend. This is also mentioned on page 51 of MMG.
  10. “While you’re waiting for your doctor, let me tell you about your Medicare options.”
    Insurance brokers and plan sponsors can never conduct sales and marketing activities where beneficiaries receive their health care services (including waiting rooms, exam rooms, treatment centers and pharmacies).See section 70.11 (starting on page 54) for more on how to properly conduct Medicare sales and marketing activities.

Medicare Compliance

Stick with compliance to avoid common CMS complaints. Stay smart. Don’t be that agent. Having AGA as your FMO partner makes that a bit easier. We provide robust compliance training on Medicare Parts C and D, as well as regular compliance tips on our social media pages (LinkedIn, Facebook, and Twitter).

You can also check out some recent Medicare compliance blog posts:

Still unclear on Medicare compliance? Have a specific question? Contact AGA any time for guidance.

Stay Informed on All Things Medicare

Nov 7, 2016 | | 0 comments


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