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The Value of Medicare Agents and the Service They Provide

When individuals approach Medicare eligibility, they often discover just how complex healthcare decision-making can be. With dozens of plan types, varying costs, evolving coverage rules, and aggressive advertising from every direction, choosing the right Medicare coverage can feel overwhelming. That’s where licensed Medicare agents bring tremendous value.

Medicare agents act as trusted advisors, providing clarity, guidance, and personal advocacy. Their goal isn’t just to help someone enroll in a plan; it’s to ensure clients understand their benefits and feel confident in their healthcare choices year after year.

Simplifying a Complicated System

While Medicare is an essential program, it isn’t always easy to navigate. Beneficiaries have questions such as:

• Original Medicare or Medicare Advantage?
• What’s the difference between a Medigap plan and a Medicare Advantage plan?
• Do I need a Part D prescription drug plan?
• What are my costs? What doctors can I see? Will this plan cover my prescriptions?

A Medicare agent breaks this information down into clear, understandable terms. They help clients compare plan options side-by-side, explain key terms like premiums, deductibles, and maximum out-of-pocket costs, and ensure beneficiaries avoid costly mistakes such as missing enrollment deadlines or choosing plans that don’t fit their needs.

Personalized Guidance

Every Medicare beneficiary has unique needs; health conditions, prescription needs, doctor preferences, budget considerations, and lifestyle factors. Independent Medicare agents take the time to understand these factors and recommend plans that offer the best fit, not just the best marketing.

Many agents represent multiple carriers, allowing them to provide unbiased comparisons and advocate for the plan that truly serves the client best.

Watch a quick YouTube video comparing Medicare Advantage vs. Medicare Supplements

Year-Round Support and Advocacy

Medicare decisions don’t end at enrollment. Plans can change their provider networks, drug formularies, premiums, and benefits from year to year. Agents ensure beneficiaries stay informed and help them:

• Review plans annually during the Annual Enrollment Period
• Understand billing and claims issues
• Navigate carrier customer service challenges
• Access additional benefits and programs that can reduce healthcare costs

This ongoing support is one of the most valuable services agents provide and it’s often at no cost to the beneficiary, since agents are typically compensated by the insurance carriers.

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Protection Against Misinformation

Medicare marketing is everywhere, and not all of it is accurate. Agents serve as a reliable source of truth, cutting through misleading ads and high-pressure sales tactics. They are licensed, trained, and required to follow strict compliance rules designed to protect Medicare beneficiaries.

A Partner in Your Healthcare Journey

Medicare agents don’t just enroll people in plans, they build long-term relationships. They offer peace of mind, help clients understand their benefits, and stand by their side when questions or challenges arise.

Agents, stay up-to-date on the our latest webinars an agent events.

For many seniors, working with a Medicare agent means having a trusted professional who knows their needs, understands the system, and is committed to helping them access the best possible care.

Relocating to a new state can be exciting, but if you rely on Medicaid for your healthcare, the process requires careful planning. Medicaid is a state-administered program, meaning benefits cannot be transferred directly from one state to another. Maintaining Medicaid when you move is essential for those who rely on that extra assistance. However, with preparation, you can make the move without losing coverage.

Understanding How Medicaid Works

While the federal government sets the foundation for Medicaid, each state runs its own program with unique eligibility rules, income limits, and coverage options. Because of this, Medicaid benefits do not automatically carry over when you move. You must close your case in your current state and reapply in your new one.

The good news: there are no residency waiting periods to apply. Once you’ve established your new address, you can submit your Medicaid application right away. In some states, nursing home residents must meet a short length-of-stay requirement (for example, 30 days) before applying for long-term care Medicaid.

Avoiding Gaps in Coverage

Many people worry about a lapse in care when switching states. While coverage in your old state ends once you move, most states offer Retroactive Medicaid; up to three months of backdated coverage for eligible medical expenses before your application month. This helps bridge the gap while your new application is being processed.

Watch a YouTube video on OEP, SEPs and Late Part B Enrollments

How State Rules Differ

Although income and asset limits vary by state, the differences are usually not drastic. If you qualify in one state, you’ll likely qualify in another. However, there are exceptions. For instance, in 2025:

• New York allows a single Medicaid (age 65+ or disabled) applicant up to $32,396 in countable assets.
• Florida limits countable assets to $2,000 for long-term care Medicaid.
• California has no asset limit for Medicaid (Medi-Cal).

If your new state has stricter limits, you may need to spend down or restructure assets to regain eligibility.

Beyond finances, states also define medical need differently. Each sets its own criteria for a “nursing home level of care.” One state might require help with two daily living activities, while another requires three. If your new state’s requirements are stricter, you may no longer meet the functional criteria.

Steps for a Smooth Transition

1. Research Early: Contact the Medicaid office in your new state before moving. Learn about income limits, medical requirements, and available programs.
2. Gather Documentation: You’ll need proof of residency, income, and identity to apply.
3. Time Your Move: Consider moving near the end of the month so your old coverage ends as your new one begins.
4. Get a Functional Assessment: If you need long-term care, have your care level assessed before canceling your old Medicaid.
5. Seek Professional Help: A Certified Medicaid Planner can guide you through financial restructuring and application preparation.

Click here for help finding a certified Medicaid planner

Medicaid isn’t portable between states, but with smart timing and preparation, you can relocate without losing essential healthcare benefits. Close your old case properly, apply quickly in your new state, and stay informed about eligibility differences. Working with a Medicaid planning professional can make the transition smoother and protect your coverage during your move.

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Humana Medicare 2026 OTC Benefits: How to Use and Access Them

Many Humana Medicare Advantage (Part C) plans include an over-the-counter (OTC) allowance to help members save on everyday health items. Fortunately, Humana Medicare 2026 OTC benefits provides members more ways to maintain their health while managing out-of-pocket costs.

What the OTC Benefit Covers

Humana’s OTC benefit allows members to buy non-prescription health and wellness products at no cost, up to a set allowance. Covered items typically include:

• Pain relievers and cold medicines
• Vitamins and supplements
• Dental care items like toothbrushes and toothpaste
• First-aid and wound-care supplies
• Digestive aids and bladder-control products

Depending on the plan, members may receive a monthly or quarterly allowance to spend. Some plans offer rollover options, while others require that unused funds be used within the benefit period.

Watch a YouTube video on Medicare Advantage vs Medicare Supplements

How to Access Your OTC Benefit

1. Confirm Eligibility – Log into your MyHumana account or review your Summary of Benefits to confirm your plan includes an OTC allowance. You can also call the Member Services number on your Humana ID card.
2. Know Your Allowance – Find out how much you receive and how often it renews. Available benefits vary by plan and region.
3. Shop for Eligible Items – You can use your OTC funds in several ways:
   • Humana Spending Account Card – Many plans load your allowance onto a prepaid card you can use at participating retailers.
   • Mail Order or Online Catalog – Some plans require ordering through CenterWell Pharmacy’s OTC catalog or online store.
4. Use It Before It Expires – Most allowances expire at the end of each benefit period or at year-end. Check your balance often to avoid losing unused funds.

Tips to Maximize the Benefit

• Review Plan Changes Annually: OTC benefits and amounts can change each year. Always read your Annual Notice of Change (ANOC) each fall.
• Shop Early and Smart: If mail order is required, place orders early to allow for shipping time.
• Combine Benefits: Some Humana plans that include Healthy Options or grocery allowances encourage clients to take advantage of all available extras.
• Keep Receipts: If questions arise, documentation helps confirm eligible purchases.
• Ask for Help: Members can contact Humana Member Services or their licensed agent for guidance.

Why This Benefit Matters

Humana’s OTC benefit helps reduce the cost of everyday health items, adding value to Medicare Advantage coverage. For 2026, these allowances highlight Humana’s focus on affordability and wellness. When clients understand and use these benefits fully, they save money, improve their health, and feel more satisfied with their plan.

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Protecting Medicare Consumers And Agents

Across the country, both Medicare and Affordable Care Act (ACA) consumers and the independent agents who serve them are facing new challenges. Many insurance carriers are reducing or eliminating commissions, restricting access to plan applications, or changing payment structures. These practices can disrupt fair competition and limit the ability of agents to provide clear, unbiased help to beneficiaries. Ther have been many people wondering; who is protecting Medicare consumers and agents amidst all this change.

To address this growing concern, NABIP has stepped forward as a strong advocate for both consumers and agents. On October 21, 2025, NABIP sent a letter to the National Association of Insurance Commissioners (NAIC) and all state insurance commissioners, urging a coordinated response to protect fairness in the Medicare and ACA markets.

NABIP’s concerns include:

• The use of “zero-commission” or drastically reduced commission structures on select plans
• Limiting or removing access to plan applications for appointed agents
• Making mid-year commission changes without proper notice
• Steering consumers toward carrier-preferred products by discouraging certain plan sales.

According to NABIP, these tactics not only manipulate markets but also restrict consumer choice and weaken the role of licensed, independent agents. Agents are essential to helping seniors and individuals with disabilities navigate complex coverage options and make informed decisions.

Watch a YouTube video on Medicare Advantge plans going non-commissionable

NABIP referenced the Idaho Department of Insurance as a model for other states

Idaho’s Bulletin No. 25-06 clarified that carriers must keep plan applications accessible to both agents and consumers, prohibit mid-year commission changes, and ensure commissions included in filed products are paid as approved. NABIP is urging every state to adopt similar protections to maintain fairness and transparency.

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Independent agents are a cornerstone of consumer protection. They act as trusted advisors who focus on client needs; not corporate preferences. When compensation is reduced or access is restricted, consumers lose guidance, choice, and confidence in the system.

NABIP continues to work with regulators nationwide, offering documentation, examples, and testimony from licensed producers. Its goal is clear: to ensure accountability, preserve competitive markets, and protect the vital connection between consumers and the professionals who serve them.

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Understanding Coordinated Care: How It Improves Health

When it comes to your health, it’s not uncommon to see several doctors, specialists, or therapists over time. But have you ever wondered who’s making sure everyone is on the same page about your care? That’s where understanding coordinated care comes in. This is an approach designed to keep healthcare connected, organized, and focused on the patient as a whole.

What Is Coordinated Care

Coordinated care is a healthcare model that ensures all members of the care team; from primary care providers to specialists, hospitals, and even pharmacists, work together to manage overall health. The goal is simple: to deliver high-quality care that meets healthcare needs while reducing confusion, delays, and unnecessary costs.

Instead of treating each health concern in separately, coordinated care looks at your entire health picture. It’s a team-based, patient-centered approach that emphasizes communication and collaboration across all your healthcare providers.

Watch a YouTube video on the Discontinued Medicare Advantage Plan Special Enrollment Period

How Coordinated Care Works

In a coordinated care system, one provider (often your primary care physician or a dedicated care manager) takes the lead in managing your treatment plan. This person acts as your main point of contact and ensures that:

• Providers share test results and medical records to forma treatment plan
• Treatments don’t overlap or conflict
• You understand your medications and next steps
• Your transition between care settings; such as from hospital to home, goes smoothly

This kind of teamwork helps prevent medical errors, unnecessary repeat tests, and medication mix-ups that can happen when care is fragmented.

Examples

• A person living with diabetes might see a primary care doctor, an endocrinologist, and a nutritionist. In coordinated care, these professionals communicate regularly to align medications, diet recommendations, and follow-up visits.
• After a hospital discharge, a care coordinator might help schedule follow-up appointments, review discharge instructions, and ensure the patient fills their prescriptions; reducing the chance of readmission.
• Many Medicare Advantage and Accountable Care Organizations (ACOs) use coordinated care models to deliver more efficient and effective care for members.

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Why Coordinated Care Matters

Coordinated care isn’t just about organization; it’s about better outcomes. When providers share information and work together, you benefit from:

• Improved overall health
• Fewer hospital visits
• Lower out-of-pocket costs
• Greater satisfaction with your care

Most importantly, it ensures that care reflects your personal goals, preferences, and lifestyle because no one’s health journey looks the same.

Coordinated care is about putting the patient back at the center of the healthcare experience. By connecting the dots between your doctors, specialists, and support services, coordinated care leads to smarter, safer, and more compassionate healthcare.

Whether you’re managing a chronic condition or just want a smoother healthcare experience, coordinated care helps ensure that every part of your health story fits together the way it should.

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Medicare Drug Cost Cap 2026

Beginning in 2025, Medicare introduced one of the most significant changes to prescription coverage in years: a yearly limit on out-of-pocket costs for medications under Medicare Part D. This change continues in 2026, with a slightly higher limit on the Medicare drug cap 2026 designed to help beneficiaries manage rising prescription expenses.

What Is the 2026 Medicare Drug Cap?

In 2026, the Medicare Part D out-of-pocket cap will be $2,100. Once a beneficiary pays $2,100 in out-of-pocket costs for covered prescription drugs in a calendar year, they will owe nothing more for those medications for the rest of the year.

This cap includes deductibles, copays, and coinsurance for covered Part D drugs, but it does not include:

• Monthly Part D premiums
• The cost of drugs covered under Medicare Part B (such as infusions administered in a doctor’s office)
• Medications not on the plan’s formulary

Whether someone has a stand-alone Part D plan or a Medicare Advantage plan with drug coverage, the cap applies to all covered prescriptions.

Why This Change Matters

Before this new system, Medicare beneficiaries had no upper limit on out-of-pocket drug costs. This meant that those with chronic illnesses or expensive specialty medications could spend thousands each year with no relief.

The new $2,100 cap gives beneficiaries greater financial protection and predictability. Once the limit is reached, cost-sharing ends, offering peace of mind for those managing ongoing or high-cost prescriptions.

The increase from $2,000 in 2025 to $2,100 in 2026 accounts for inflation and rising drug prices. This cap is part of the Inflation Reduction Act (IRA), which aims to make medications more affordable and includes additional measures like insulin cost caps and Medicare drug price negotiations.

How the Cap Works

Here’s an example:
Suppose Mary, a Medicare beneficiary, pays copays and coinsurance for her medications throughout 2026. Once her total out-of-pocket spending for covered Part D prescriptions reaches $2,100, she won’t have to pay anything else for those drugs for the rest of the year.

However, it’s important to note that costs for non-covered or Part B drugs won’t count toward the cap. Also, her monthly plan premiums remain separate and will continue.

Watch a YouTube video explaining the drug cap

What Beneficiaries Should Do

Even with this welcome protection, it’s crucial to review your plan each year during the Medicare Annual Enrollment Period (October 15 – December 7). Here’s what to consider:

• Check your plan’s formulary: Make sure all your prescriptions are covered.
• Compare plan costs: Premiums, deductibles, and copays can vary widely between plans.
• Track your spending: Plans will monitor your progress toward the cap, but keeping your own records is wise.
• Explore payment options: The new Medicare Prescription Payment Plan allows beneficiaries to spread out their drug expenses evenly throughout the year instead of paying large costs upfront.

A Step Toward Affordability

The 2026 Medicare drug cost cap is a milestone for millions of Americans who depend on prescription medications. While it doesn’t eliminate all costs, it offers much-needed relief and certainty for those facing high drug expenses.

By understanding how the cap works and reviewing coverage carefully, Medicare beneficiaries can make informed decisions and take full advantage of this new protection.

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Medicare Agents as TPMOs: Compliance and Best Practices for Medicare Agents

As a Medicare agent, you are more than just a licensed professional helping beneficiaries find the right coverage; you are officially recognized by CMS as a Third-Party Marketing Organization (TPMO). Understanding Medicare agents as TPMOs is crucial to protecting your business and staying compliant.

What Is a TPMO

CMS defines a TPMO as any organization or individual compensated to perform lead generation, marketing, or enrollment activities for Medicare Advantage (MA) or Part D plans. That means independent agents and brokers fall under the TPMO umbrella whenever they market or sell these plans.

Why It Matters

The TPMO designation exists to ensure transparency, accountability, and consumer protection. CMS tightened these rules in response to misleading advertisements and beneficiary confusion. As a result, every agent who sells MA or Part D plans must meet strict communication and documentation requirements.

Watch a video on the FCC one to one consent rule

Key Compliance Requirements

Here are the most important rules every TPMO must follow:

• Mandatory Disclaimer: Every piece of marketing material, website, or verbal outreach must include the approved CMS disclaimer: “We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.”
• Call Recording: Any phone call that discusses MA or Part D benefits; even informational calls must be recorded and securely stored for at least 10 years.
• Scope of Appointment (SOA): Always obtain an SOA before discussing plan details. Electronic and paper SOAs are acceptable but must be saved for recordkeeping.
• Avoid Misleading Language: Never imply government affiliation or say you offer “every plan” unless that is true. Be careful with phrasing on social media, websites, and mailers.

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Best Practices for Sales and Marketing

To remain compliant and build trust with clients:

• Lead with education, not sales. Help beneficiaries understand their options before recommending a plan.
• Use CMS-approved materials. Avoid customizing carrier pieces unless approved for agent use.
• Document everything. Keep records of calls, SOAs, and marketing pieces.
• Stay current on CMS updates. Rules can change annually; follow your FMO and carrier training closely.

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Being classified as a TPMO isn’t just a compliance label; it’s a reminder that agents play a critical role in maintaining Medicare integrity. By following CMS rules, staying transparent, and putting client education first, you protect both your license and your reputation in the Medicare marketplace.

Why Medicare Star Ratings Matter – Understanding Their Importance

When comparing Medicare Advantage or Part D prescription drug plans, you’ll see a “star rating” next to each one. These ratings aren’t just numbers; they reflect the overall quality and performance of a plan. Knowing why Medicare star ratings matter can help beneficiaries make a more confident, informed choice.

What Are Medicare Star Ratings

Each year, the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (MA) and Part D plans on a 1-to-5-star scale, with 5 stars being excellent and 1 star being poor.

CMS evaluates plans based on key measures such as:

• Preventive care and managing chronic conditions
• Member satisfaction and customer service
• Medication safety and accuracy of drug pricing
• Handling of complaints and appeals

These ratings help beneficiaries compare plan quality; not just costs.

Why Star Ratings Matter to Beneficiaries

1. Quality Over Cost
   A low monthly premium might look appealing, but a lower-rated plan could have poorer customer service or fewer care management programs. Star Ratings help you see the bigger picture.
2. Better Health Outcomes
   High-rated plans generally perform better in preventive care, chronic condition management, and prescription safety leading to improved member health.
3. Special Enrollment Advantage
   If a 5-star plan is available in your area, you can use the 5-Star Special Enrollment Period to switch once a year, even outside regular enrollment periods.

Watch a YouTube video on special enrollment periods

Why Star Ratings Matter to Carriers

For insurance carriers, these ratings are more than just feedback — they directly affect their business.

• Financial Rewards: CMS provides quality bonus payments to plans with ratings of 4 stars or higher. These bonuses can help carriers enhance benefits, reduce premiums, and remain competitive.
• Reputation and Market Growth: A higher-rated plan attracts more enrollees. Consumers often view Star Ratings as a trusted indicator of quality and satisfaction.
• Compliance and Accountability: Consistently low ratings can lead to penalties or even removal from the Medicare program. This motivates carriers to continuously improve service, communication, and care coordination.

In short, the Star Rating system drives both accountability and quality improvement for carriers and members alike.

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The Bottom Line

Medicare Star Ratings serve an important purpose for everyone involved. They help beneficiaries choose better plans, encourage carriers to maintain high standards, and ensure that Medicare funds support quality care.

When reviewing plans, remember; the stars tell a story about value, performance, and member experience. Taking time to understand them can make an important difference in satisfaction with healthcare coverage.

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Reasons for MA Plan Cuts – What’s going on

Recently, many insurers are pulling back or dropping Medicare Advantage plans in certain counties. Many Medicare advantage carriers are reducing offerings. This is especially true for PPO plans, which tend to be less restrictive for patients, but also costlier/riskier for insurers. Here’s a breakdown of the reasons for MA plan cuts and why some Medicare Advantage (MA) plans are leaving the market, what it means for enrollees, and how to prepare.

Why Some Medicare Advantage Plans Are Leaving the Market

In 2025 and beyond, several major insurers are scaling back or exiting certain Medicare Advantage (MA) markets. Companies like UnitedHealthcare, Humana, and Aetna are discontinuing specific plans or leaving select counties, affecting hundreds of thousands of beneficiaries. So, what’s driving these exits and what does it mean for Medicare enrollees?

Rising Costs and Slower Reimbursements

The main driver behind these exits is financial pressure. Health care costs; doctor visits, hospital stays, and prescription drugs continue to rise. Meanwhile, the Centers for Medicare & Medicaid Services (CMS) has limited how much funding increases for MA plans each year.

When reimbursement rates don’t keep pace with actual medical spending, insurers are forced to make tough decisions. Some reduce coverage areas; others leave markets entirely. The challenge is even greater in rural counties, where fewer enrollees mean higher per-member costs and less opportunity to spread financial risk.

Increased Regulation and Administrative Burdens

Medicare Advantage plans are subject to strict federal oversight. CMS star ratings, which measure quality and satisfaction, directly affect plan payments and bonuses. Plans with low ratings can face penalties or reduced funding.

New rules around prior authorization, marketing practices, and network adequacy have also added administrative costs. While these policies aim to protect consumers, they make operating certain plans more expensive and complex; especially for smaller carriers.

Shrinking Margins and Risky Plan Types

Preferred Provider Organization (PPO) plans, which allow greater provider flexibility, are especially expensive for insurers to run. In response, many companies are narrowing their focus to Health Maintenance Organization (HMO) plans with tighter networks and lower costs.

However, even with these adjustments, many insurers report that the combination of higher utilization, slower reimbursements, and increased regulation has made some plans unsustainable. As a result, certain counties are seeing fewer plan options for 2026.

Cutting Back on Benefits

To stay competitive and manage costs, insurers are also reducing extra benefits that have become popular selling points for Medicare Advantage plans.

Perks such as dental, vision, hearing, over-the-counter allowances, and fitness memberships are being scaled back or dropped altogether. Some plans have increased copays for specialists, raised out-of-pocket maximums, or restricted drug formularies.

While these changes help insurers control spending, they can leave beneficiaries with fewer incentives to stay on a plan—prompting more people to explore other options like Original Medicare with a Medigap supplement.

What This Means for Beneficiaries

If your Medicare Advantage plan is ending or changing benefits, you’ll receive an Annual Notice of Change (ANOC) this fall. It’s important to read this document carefully. You may find that your premiums, networks, or covered benefits are changing even if your plan remains available.

Here’s what to watch for:

• Fewer local plan options—especially in smaller or rural markets.
• Higher out-of-pocket costs due to benefit reductions or network changes.
• Provider access changes as plans narrow their networks.
• Reduced extra benefits, such as dental, vision, and wellness perks.

Watch a video on discontinued Medicare advantage plan special enrollment periods

If your plan is leaving your area entirely, you’ll qualify for a Special Enrollment Period (SEP) to choose a new plan or return to Original Medicare.

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What You Can Do

1. Review your ANOC early to understand all upcoming changes.
2. Compare new plans on Medicare.gov or with a licensed agent to see what’s available in your ZIP code.
3. Look beyond the premium. Consider total out-of-pocket costs, copays, and your provider network.
4. Verify your prescriptions. Ensure your medications are still covered under the plan’s formulary.
5. Explore Medigap and Part D options if you want more stability or broader provider access.

The Bottom Line

Medicare Advantage remains a strong and growing program, but rising costs and tighter reimbursement rules are forcing insurers to reassess their participation. Many are choosing to leave certain counties or reduce extra benefits to stay financially viable.

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For beneficiaries, staying informed is key. Review your plan each year, compare options carefully, and don’t assume your current benefits will stay the same. A little preparation can help avoid surprises and ensure you continue to get the coverage and care you need.

Medicare Sales Compliance Rules – What Not to Say During a Medicare Sale

When you with meet with Medicare beneficiaries, the words you choose matter. CMS has strict marketing guidelines, and violating them can lead to serious issues, this includes fines or even loss of contracts. To protect your clients and your business; we will go over some Medicare Sales Compliance Rules regarding things Medicare agents cannot say or do during a sales appointment.

“We offer every Medicare plan available”

This statement is misleading. Not all plans contract with independent agents, and no agent can truly offer every plan. You may represent several excellent plans, but accuracy is essential. Always choose wording carefully on printed materials and in conversations.

Remember: CMS requires TPMOs (Third-Party Marketing Organizations) to include a disclaimer on all marketing materials, communications, and even phone calls with prospective clients.

“This plan is free”

CMS marketing guidelines prohibit agents from using the word free to describe any plan.

• A $0 premium does not mean the plan has no costs.
• Enrollees are still responsible for deductibles, co-pays, and coinsurance.
• Network restrictions often apply.

The word free is misleading and should never be used when describing Medicare plans, premiums, deductibles, or cost-sharing.

Watch a YouTube video on CMS final rule 2026

“This plan covers everything you need”

There is no Medicare plan that covers all of someone’s health needs. The agent’s role is to help clients compare options and choose what best fits their personal situation. Present the pros and cons, but never promise that a plan will meet 100% of their needs.

“This is the best plan”

Superlatives like “best” are not allowed unless supported by verifiable, CMS-approved data. What’s best for one client may not be best for another. Always focus on what meets that client’s needs, not a blanket claim.

“Medicare approves this plan’s benefits”

You cannot say or imply that Medicare endorses, approves, or recommends a plan. While Medicare Advantage and Part D plans must meet CMS standards, they are offered by private companies; not by Medicare itself.

Talking about non-Medicare products during an SOA

Stick to the Scope of Appointment (SOA). If the SOA only covers Medicare Advantage, you cannot bring up Medigap, Part D, or life insurance. If a client asks about other products, suggest scheduling another appointment.

Asking for friends’ or family contact info

You cannot request phone numbers or addresses of potential referrals. What you can do is hand clients extra business cards so they can share your information with others who may be interested.

Offering gifts or money for enrollment

Agents cannot provide financial incentives or high-value gifts in exchange for signing up. CMS allows small promotional items (worth $15 or less per item, up to $75 per year per person).

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Scare tactics or misinformation

Do not tell clients their current coverage will change just to push a new plan. You may compare benefits factually but avoid scare tactics. Clients must feel educated, not pressured.

Medicare compliance is about accuracy, transparency, and respect. Stick to CMS-approved language, avoid misleading claims, and always tailor your advice to the individual client. Doing so not only keeps you compliant; it builds lasting trust.

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