CMS has strick regulations in place for anyone offering Medicare plans over the phone. Agents who do not adhere to the rules could face strict penalties. Penalties can include; loss of contracts, monetary fines and damage to your professional reputation. To ensure compliance and build trust with potential enrollees, here are some tips for conducting compliant Medicare phone sales.
Obtain permission to contact
CMS rules strictly regulate how and when agents can contact potential enrollees. If you are calling about Medicare Advantage or PDP plans, to remain compliant; be sure to have documented permission to contact before making outbound calls. Do not cold call or use leads that did not provide consent for the call. Follow all CMS guidelines regarding unsolicited communications, this includes text messages and voicemails.
Comply with Do-Not-Call (DNC) regulations
Agents must respect consumer preferences regarding contact. To comply; make sure you use phone leads that are cross checked with the National Do-Not-Call Registry. Even when you do this, keep in mind the FTC updates the list constantly and you face a fine if you contact someone who is on that list.
Use approved scripts and disclosures
When discussing Medicare plans, agents must adhere to CMS-approved scripts and include required disclaimers.
Agents must clearly state that they do not represent or work for Medicare, but rather the specific carriers and plans they are contracted with. There are standard disclaimers that must be read to prospects. This includes: “We do not offer every plan avialable in your area”. It is always important to provide acurate plan information and do not mislead or pressure the consumer.
Watch a quick YouTube video on updates to the one-to-one consent rule
Avoid prohibited sales tactics
Medicare has strict guidelines against high-pressure sales tactics. Agents should not mislead beneficiaries into thinking they must enroll in a plan immediately (high pressure sales). They must not make unsupported claims about plan benefits or when comparing plans. Always allow the prospect to ask any questions they have and be sure they understand what is said.
Follow call recording and documentation rules
CMS requires that all Medicare Advantage and Part D sales calls be recorded in their entirety. In order to be complaint; calls must start with a disclosure that the conversation is being recorded, the prospect must give permission for this.
Agents must keep call recordings for a period of no less than 10 years as required by CMS and the carrier. It is important to document all client sales interactions; this protects both the agent and the client. A SOA is an important part of this process.
The SOA (Scope of Appointment)
When conducting a Medicare sales call, agents must adhere to the agreed-upon topics. Do not discuss additional products that are not included in the SOA. If the client wants to talk about other products, you must collect a new SOA that covers them. In order to be compliant, agents should keep the SOA for a period of 10 years.
Learn more about SOAs
Provide clear and accurate information
Misinformation or omitting critical details can lead to compliance violations. Make sure you know what the beneficiary is looking for. Discuss current coverage, doctors, medications and their needs and budget.
To maintain integrity, explain benefits, costs and network limitations clearly. Ensure enrollees understand the differences between the plan types (Medicare Advantage, Supplements & PDPs).
Ensure post-enrollment compliance
Your responsibility does not end after enrollment. To ensure your client is happy with their choice, make followup calls and discuss any questions or concerns they have. Make sure they understand their new plan benfits and how to use them. This helps keep clients happy and also helps avoid rapid disnerollments and chargebacks.
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Staying compliant in Medicare phone sales is crucial to protecting consumers and maintaining your credibility as an agent. By following CMS regulations, using approved scripts, and respecting consumer rights, agents can foster trust and ensure ethical sales practices. Always refer to the latest CMS guidelines or seek guidance from a your upline.