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48 hour scope of appointment

Agents who plan to offer Medicare Advantage or Medicare Part D coverage to beneficiaries, need to understand the CMS 48 hour scope of appointment rule.

Watch a quick YouTube video on the 48 hour rule

A SOA (Scope of Appointment) is an agreement that both the agent and client must sign before a scheduled in-person, phone or online appointment.  The SOA shows exactly which products the client and agent plan to discuss at their meeting.  This gives the agent as well as the client time to prepare for the discussion and helps to avoid high pressure sales tactics. This document is mandatory if there is a discussion about either Medicare Advantage and/or Part D prescription drug plans.

A scope of appointment may list several types of products the client wants to discuss, or it can be a basic form that lists only Medicare Advantage plans, Part D (PDP) plans, Ancillary products and Medicare supplements.  The products the beneficiary checks off are the products the agent has permission to discuss.

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How far ahead of time can you get the SOA

A signed SOA is good for up to 12 months before you meet with the client.  Some agents collect a new SOA at the end of an appointment to be prepared for the next meeting ahead of time.  It is important to remember the scope is only good for 12 months, once that time has passed, the client will need to sign a new scope.

Exceptions to the rule

1. One exception to the rule is the last four days of a valid election period. during the last four days of a valid election period.  At this time, agents can collect a same day Scope.
2. Another exception applies when the beneficiary walks into the agent’s office without an appointment. This is a beneficiary-initiated meeting, also referred to as a “walk in”.
3. The final exception is when the beneficiary calls the agent without a scheduled appointment.  This is a beneficiary-initiated call, therefore the 48 rule does not apply.

The CMS call recording requirements; learn more.

Ways to collect a SOA

Although the 48m hour rule was put in place as a way to protect beneficiaries, some may not like the inconvenience of having to meet twice to discuss their plan options. It is important to discuss the reason this rule is in place and let clients know you believe it is important to abide by the rules to maintain your integrity.

Please note; there is more than one way to comply with the 48 hour SOA rule.  Many carriers provide tools that allow agent to collect a voice scope.  Some Medicare FMOs also provide tools that not only provide voice scope tools but also call recording tools for voice enrollments.

Learn more about call recording requirements.

Of course, you can collect a paper scope if your client is willing to meet and sign at least 48 hours before your discussion.  You can also email the scope ahead and have the client send it back to you.  There are also tools such as Sunfire and Connecture that allow agents to send a link for clients to complete an online Scope before the meeting.

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Medicare sales permission to contact

When you have a potential clients you need to keep all the CMS guidelines in mind before you begin.  You need to be compliant and use a Medicare sales permission to contact.

What is Permission to Contact:

This process helps stop agents from contacting beneficiaries through the use of dishonest sales tactics. Unfortunately, in the past, some agents have pressured Medicare beneficiaries to get a Medicare sale.  Permission to contact is one way to help deter uninvited agents to approach beneficiaries when they are not prepared.

To avoid non compliance, it is important the beneficiary gives permission for the agent to contact them before you try and meet, call or email them for Medicare Advantage or PDP sales.

Here are some ways you can contact a potential client:

1. You can return their call if they request you do so.
2. Through email as long as there is an opt-out option clearly provided.
3. If they respond to a business replay card.
4. When they fill out an online contact form.

Here are some ways you cannot contact a potential client:

1. Do not knock on a potential client’s door without an invitation.
2. You are not permitted to send texts to anyone without their permission.
3. Directly contact through social media

When is permission to contact required:

Anytime you want to contact a potential client, you should obtain permission to contact.  This is very important if they may be considering a Medicare Advantage or Prescription Drug Plan enrollment. Please note; even if you contact a potential client for a Medicare Supplement plan which does not require permission to contact, they will most likely need a Prescription Drug Plan to go with it, therefore it is always a good idea to have permission to contact.  Be sure to include the following disclaimer “This is a solicitation of insurance” on the Permission to contact form.

Please note: If you are contacting your own clients; you do not need permission to contact.

It is acceptable to email potential clients as long as you include an opt-out option.  You cannot send anything that could be considered marketing material.  Marketing material includes specific plan information such as premiums, co-pay amounts or other benefit information. All communications must meet CMS guidelines as well as  CAN SPAM Act requirements.

How long is the permission to contact good for:

Once you have collected the permission to contact, you have 12 months to contact that beneficiary.  If you do not contact them within that time, you must collect another PTC before contacting them.

A couple more things to note:

If you employ a third party marketing organization for lead generation, it is important that they are compliant with all the CMS rules.  Do not forget, it is your name on the materials they are sending so you are the one who is ultimately responsible for what goes out to the public.  Beneficiaries need to be told either verbally, in writing or electronically depending how they are contacted, that their information will be given to a licensed Medicare agent who will contact them.

Do not confuse permission to contact with a Scope of appointment.

You still need to collect a scope of appointment from the beneficiary once you are able to set up a meeting or call to go over plan options.  It is important to follow all guidelines for Medicare sales in order to maintain compliance and maintain your ability to offer Medicare plans.

Download a generic scope of appointment form

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2024 CMS Regulations Compliance: Medicare Advantage Advertising

Agents must stay abreast of the yearly changes to the Center for Medicare and Medicaid Services’ (CMS) regulations. For the coming year, 2024, there are new regulations to observe in the realm of advertising and marketing.

For Third Party Marketing

• TPOs submit all marketing materials for Medicare Advantage and Prescription Drug Plans, or Part D plans to CMS before use.

• Use only Marketing materials  approved by CMS.

• Online videos or television advertisements used in marketing are subject to a 45-day review period by CMS.

• Allow  carriers to preview and approve materials  before submitting to CMS’ Health Plan Management System (HPMS).

These new guidelines mean that even advertisements that do not mention any specific plans by name are considered marketing materials and must be submitted to the CMS HPMS for approval prior to their use.

What Agents Need to Know

Use either carrier-created advertising materials or create communications rather than marketing materials. Communications are defined as ads that do not have intent or content.   These are compliant with CMS, state, and federal guidelines. Because communications are not marketing materials, they do not need to be submitted to CMS prior to use.

CMS will withdraw any marketing materials that are no longer in compliance.

Agent-created multi-plan marketing materials will need to be submitted separately to compliance. Send these to the carriers listed for review and possible approval. After approval,  file the materials with CMS’ HPMS. The insurance carriers will conduct their own reviews. All submitted materials will need a Standard Material ID on them (SMID), and agents and their agencies are responsible for creating and tracking those IDs.

Disclaimer Requirement

Include an additional disclaimer on all marketing materials.  This is required for the 2024 contract year Agents who do not sell for all carriers in a service area must include the following on their materials on and after September 30:

We do not offer every plan available in your area. Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

For agents who do sell for all of the insurance carriers in a service area, the following disclaimer is required:

Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. You can always contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) for help with plan choices.

These disclaimers must be written on printed marketing materials, visible on email communications, and visible in any television or internet ads, as well as displayed on websites.

FAQs:

Q: Are all marketing materials impacted?

A: Yes. All partners who create or use multiplan marketing materials must submit their materials to the compliance email address. Use the carrier created ad materials.

Q: Can I market new plans prior to October 1st?

A: No, agents cannot market new plans for the coming contract year prior to October 1st.

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