Medicare scope of appointment rules
The Medicare scope of appointment rules are put in place by CMS. The SOA (scope of appointment) is a form that clients or potential clients as well as their agent must complete before meeting to discuss Medicare plan options. The scope is mandatory if you are discussing either a Medicare Advantage or Part D prescription drug plan. Although, it is a good idea to collect a SOA before any client meeting to protect both the agent and the client. The SOA form should be kept no less than 10 years and may be collected either physically, verbally or electronically.
Verbal scope of appointment
When the pandemic began, it was not advisable to host in-person meetings to discuss coverage options. Because of this, many appointments took place over the phone. That lead to the use of verbal scope of appointments which are recorded and saved. Many carriers offer this option as well as quoting/enrollment tools such as Sunfire and Connecture.
General information about a verbal SOA
- If the client calls the agent (inbound call), the 48-hour rule does not apply.
- The scope is good for 12 months from the date it is signed. You must complete the appointment within that time or obtain a new scope. The scope is still good if the call drops and the same agent calls the client back.
- If additional benefits are added to the discussion, a new scope is necessary.
How long is a SOA good for
As we mentioned above, a scope of appointment is good for 12 months from the date it is signed. It is important that you discuss only products that were agreed to and included in the scope. If additional products are added, the beneficiary needs to sign a new scope.
If the client asks about Medicare Advantage plans during the 48-hour waiting period and they had not included them on the original scope, you will need to have them sign a new scope before your discussion. This will restart the 48-hour waiting period and may move your meeting date out further. This rule applies to any product regulated by CMS.
In order to be complaint with CMS, agents need to have their clients complete a Medicare Scope of Appointment form. The 2024 CMS final rule went into effect September 30. 2023 and has added some changes to how agents obtain the SOA.
The SOA rules apply to agents and brokers who discuss Medicare coverage options and plans. The 48-hour rule was put in place so beneficiaries could avoid the high-pressure sales tactics some agents use. The 48-hour period provides beneficiaries time to consult friends, relatives or anyone they like to research their options. This time also provides agents time to prepare for the discussion.
Agents are able to contact the beneficiary once the SOA is completed for up to 12 months. It is essentially permission to contact until the meeting takes place. The beneficiary has the option to opt out annually.
Please note, if the beneficiary does not select a coverage option on the SOA, Medicare requires the agent to avoid discussing that option without a new SOA where the option is clearly selected.
Exceptions to the 48-hour rule
If the beneficiary is in the last four days of a valid election period, agents may collect a same-day SOA.
When the beneficiary walks into your office and initiates a conversation about coverage options, agents can take a same-day SOA. This same rule applies to inbound call initiated by the beneficiary to the agent requesting advice.
How long do you need to keep a SOA
Agents must be able to access the SOA form for ten years. Clients have the right to request a copy anytime within that time frame without any issues. The SOA can provide help in the event that an issue or dispute occurs. The Scope is in place to protect the consumer, but it can also protect the agent.