6 things not to say at a Medicare Consult - CMS Compliant

6 Things Not to Say at Medicare Consultations

Aug 24, 2020

The Annual Enrollment Period is around the corner.  As you begin to prepare for your Medicare sales appointments it is important to make sure you remain CMS compliant in all activities including in-person sales meetings.  To give you a head start, we’ve compiled a list of six things you should never say during a Medicare consultation. 

1. “I’m a Medicare agent.”

One of the first rules every Independent Insurance Agent should be aware of is, 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 and on all marketing materials such as your website and business cards.

Refer to section 30.7 on page 10

2. “Free premiums!”

When it comes to Medicare sales, the word “free” should not be part of your vocabulary. While certain Medicare plans may have $0 premiums and copays they generally pertain to specific areas and plans and are not entirely free. These plans can still have deductibles, coinsurance costs, and other network requirements. Using the word “free” can be very misleading and is considered prohibited terminology by CMS as outlined in the Medicare Communications and Marketing Guidelines handbook. To remain CMS compliant use phrases such as “zero dollar premium” and “reduced deductible.”

Refer to section 30.7 on page 10

3. “If you like this plan, you should hear about this life insurance plan.”

Cross-selling non-health related products such as life insurance, annuities, etc are prohibited during a Medicare sales appointment.

Refer to section 50.3 on page 17

4. “You need this plan, it’s the best and will cover all your needs.”

Misleading a client into signing up for a certain Medicare plan is not only a poor sales tactic, but it is also not CMS compliant. Pushing a plan as all-inclusive or using misleading language like “best” can be extremely confusing to a new Medicare beneficiary. At the end of the day, education is your best tool for successful and trustworthy Medicare sales.

Refer to section 30.7 on page 10

5. “If you are ready to sign up, I can take your payment info over the phone”

Asking for payment over the phone or online is also a prohibited activity. All plans must send a bill to the recipient’s address.

Refer to Protecting Yourself & Medicare from Fraud

6. “Do you know anyone else who is interested in Medicare? I can give them a call.”

You may be wondering, “how can I get referrals if I’m not allowed to ask?” Well for starters, asking is okay, it’s what you ask for is where the rule comes into play. Asking for a phone number is considered a prohibited Medicare marketing practice. Instead, you can ask a client to mention your name to others, or you can simply stick to the tried and true method of handing out business cards.

Refer to section 40.3 on page 12

Worried your Marketing Practices aren’t compliant? Let AGA’s Compliance department take a look.


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