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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