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Marketing
If used in a misleading way, agents may not have “Medicare” in their business name, logo or URL. The concern is that beneficiaries are being misled into believing they are communicating with the federal government or its representatives.
CMS restricts the use of the Medicare name and logo. Agents can describe product types - Medicare Advantage, Medicare Supplement-in advertisements. Agents may not use an image of a Medicare card as that can be considered deceptive marketing. Agents may, however, use a generic card with the word “Medicare” on it for education purposes. Two examples of what is / is not allowed are below.
ALLOWED
NOT ALLOWED
The difference between marketing materials and communication materials in the context of Medicare plans is primarily based on the intent and content of the materials.
Marketing materials are specifically designed to influence a beneficiary's decision regarding a Medicare plan enrollment. They include information on plan benefits, premiums, or incentives to join a particular plan.
Per CMS, marketing materials or activities include or address content regarding:
- The plan's benefits, benefits structure, premiums, or cost sharing,
- Measuring or ranking standards (for example, Star Ratings or plan comparisons), or
- Rewards and incentives
Communication materials, on the other hand, are more informational and educational in nature. They provide general information about Medicare, including coverage options and rights and responsibilities, without steering towards a specific plan.
The same CMS guidelines apply to marketing materials for non-English speaking beneficiaries and ensure linguistic accuracy and cultural sensitivity.
If your marketing material falls into the definition of “marketing” (see above), you are required to seek approval by submitting it to this form.
Marketing materials should be submitted to Spark via the form above and we will submit it to CMS on your behalf (or determine that we do not need to submit it to CMS if it is a generic material).
- If your flyer mentions specific plans and companies, you are required to submit the material to CMS.
- We are able to submit to CMS on your behalf; the typical turnaround time can be 3 weeks up to 6 weeks before Annual Enrollment Period.
- However, upon review, the material may qualify for “file and use”, so that you can use the material 5 days following submission.
No. You do not need to re-submit. CMS also approves of using placeholders; for example, you do not need to re-submit materials if you are swapping in/out headshots.
Standardized material identification; this is the code that CMS uses to identify materials, and follows this convention: MULTIPLAN_[name_of_your_marketing_piece]_M
Click this link to see disclaimers and to build your own disclaimer Disclaimers
- For the materials that you want to mail, CMS requires that these types of marketing materials must be targeted based on where the mailer is used, which equates to the specific number of carriers and plans within the given service area where the mailer is sent.
- Additionally, you mentioned that the mailer will direct consumers to a website where you will then market to them across zip codes. For websites, CMS allows you to populate the TPMO disclaimer with carrier and plan numbers representative of your national footprint, until you know the beneficiary’s zip code. Once the zip code is known, the TPMO disclaimer should be populated with the number of carriers and plans offered in that zip code/geographic area. The landing page of your website can be the “national footprint” total until zip code is known.
- Below are both TPMO disclaimers based on what was discussed above. Please let us know if you have any questions. compliance@sparkadvisors.com
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Marketing messages aimed at generating interest or leads during the OEP are generally prohibited, unless as noted below. For example, a generic marketing line of “not happy with your plan, change now” would be considered inappropriate marketing. If messaging specifically calling out the OEP is sent, it would be knowingly targeting.
If a plan or an agent was aware that an individual had already made an AEP enrollment decision, sending unsolicited marketing materials to that individual, even if the OEP was not mentioned, would be considered “knowingly targeting.”
You are able to:
- Provide educational materials or marketing materials if and when the beneficiary proactively reaches out looking for help. Providing marketing materials and other information in response to a request from a beneficiary is at the beneficiary’s request and hence not unsolicited.
- Marketing to dual-eligible and LIS beneficiaries who, in general, may make changes at least once per calendar quarter during the first nine (9) months of the year.
- Market 5-Star plans, as individuals can enroll into the 5-Star plan at any time using the 5 Star SEP.
- Use mailings or other marketing aimed at individuals aging into the Medicare program unless the plan knows the individual has already made an enrollment decision. For example, a plan/agent buys a list of age-ins and sends marketing mailers to all addressing their newly eligible Medicare status. Since the plan/agent has no way to know if any of these age-ins already selected a plan it is not considered knowingly targeting during the OEP, provided the content of the message is about their Initial Coverage Election Period and does not address or include any references to the OEP.
Enrollment
PTC is when a beneficiary gives the agent express permission to be contacted about Medicare products. You, as an agent, need it anytime you want to start a conversation about Medicare Advantage and Prescription Drug plans. (Even though Medicare Supplements don’t fall under the same CMS rules as MA/PDP, it’s inevitable that you as an agent will discuss prescription drug plans along with a Med Supp, so we encourage getting PTC for all product types.
You do not need PTC if the beneficiaries are in your current book of business.
PTC must be in writing, so be sure to use a CMS Compliant Business Reply Card (BRC). PTC expires 12 months from signature date. The Spark platform has a compliant digital version for agents to use
There is an exception under CMS rules regarding unsolicited emails. Agents may send unsolicited emails to beneficiaries to market their products, BUT the email must have an opt-out option and the email cannot contain “marketing material” such as plan premiums or benefit information. Emails must also meet CAN SPAM Act requirements (CAN SPAM Act Requirements).
CAN | CAN’T | |
May send out business reply cards (BRC) | Cannot send unsolicited text messages, leave voicemail messages, send direct messages through social media. (including under the guise of selling a non-MA/PDP product) | |
May call a beneficiary who has expressly given advance permission (submission of a business reply card or scope of appointment)
| Cannot approach beneficiaries unsolicited (door to door, walking up to cars, approaching in parks and supermarkets) | |
If agent has a pre-scheduled appointment, and the enrollee is a no-show, may leave information at the enrollee’s residence | May not market to beneficiaries door to door, including leaving materials at a beneficiary's doorstep. | |
May call beneficiaries who attended a marketing/sales event if prior permission was given and documented. | Cannot collect PTC for spouse (each individual must give express permission) |
A Scope of Appointment (SOA) is a form that a beneficiary fills out, signs and dates giving permission to a licensed agent to discuss specific products with the beneficiary during the appointment. The beneficiary must initial the boxes next to the product(s) he/she is wanting to discuss during the appointment. The products discussed are limited to only what’s recorded on the signed SOA.
SOA can be a:
-CMS approved paper SOA with a wet signature
-CMS approved electronic SOA with digital signature (Spark supports this on Sunfire)
-CMS approved verbal SOA if conducting a telephonic sales appointment and enrollment (Spark supports this on call recordings)
When does the beneficiary need to fill out the form?
At least 48 hours prior to the appointment taking place. Exceptions to the 48 hour rule include when a beneficiary is four days or less from the end of a valid enrollment period (AEP, OEP, SEP, ICEP), or unscheduled in-person meetings (walk-ins) initiated by the beneficiary. You must still collect the SOA prior to talking with the beneficiary about their plan options. If conducting a telephonic appointment, the agent must follow a CMS approved script to obtain a verbal SOA prior to talking about plan options.
How long is the SOA valid?
SOA is valid for a 12-month time period from the beneficiary’s signature date. If the appointment needs to be rescheduled or the beneficiary wants time after the appointment to think about their options, agents may use the same SOA within the 12-month period.
Other things to note about SOA’s:
- SOA’s must be kept for 10 years, including audio files for verbal SOA’s
- SOA’s are generally required to be submitted with all enrollment applications; although some carriers may only require upon request. Check for carrier specific instructions.
- You are not allowed to hand out and/or collect SOA’s at educational events.
You must record all calls (inbound and outbound) related to marketing, sales, and enrollment. This applies to all agents (field, call center, and captive). This includes:
- Individual plan recommendations for the client (sales appointments)
- Completion of an enrollment application with the client
- Over the phone Scopes of appointment
- Retention-based marketing calls (influencing a beneficiary’s decision to stay enrolled in a plan)
- Marketing also includes materials that mention any benefits, including widely available benefits such as dental, vision, hearing, premium reduction, cost savings.
Agents should not need to record calls simply to set appointments or check in after sales.
I receive an Allegation from a Carrier. What should I do?
Events & seminars
The Medicare Communications and Marketing Guidelines (MCMG) differentiate between educational and marketing events. At educational events, the focus is on informing beneficiaries about Medicare Advantage, Prescription Drug, or other Medicare programs without steering them towards a specific plan. Agents/presenters are not allowed to discuss any individual plan specific information such as premiums, co-pays, or plan specific benefits.
Educational Events should be held in a public setting, such as a restaurant or public library. They should not be held in-home or one-on-one settings.
Educational Events do not have to be filed with CMS.
You can advertise Educational Events through most forms of media including newspaper, radio, flyers, direct mail and social media. There are a few guidelines when marketing educational events:
- All educational events must be explicitly marketed as “educational” to beneficiaries
- Ads and invitations must contain this disclaimer: “For accommodations of persons with special needs at meetings call <insert phone and TTY number>.” Click this link for more information on TTY.
Agents are allowed to have other “community partners” co-sponsor and be present at the event. Examples include Realtors, Financial and Investment Advisors, and other senior focused businesses in the area.
Meals may be provided at educational events. There is currently (2024 selling year) not a dollar limit on the meals as CMS has excluded meals at an educational event under the nominal gift rule. See page 10 of Medicare Communications and Marketing Guidelines (MCMG): CMS MCMG
Here are more Do’s and Don’ts for Educational Events:
DO’s | DON’TS |
Provide generic business reply cards (BRC) to attendees. | Display a sign-in sheet to collect contact info. |
Give out business cards and contact information for beneficiaries to initiate contact with agent/agency
| Hand out applications/’enrollment forms or any materials or give aways that contain specific plan information |
Use handouts that are generic and educational in nature | Provide or collect SOA’s, schedule future appointments |
Give an informative and educational presentation and answer attendee questions | Hold a marketing event within 12 hours of the educational event in the same or adjacent building |
Provide snacks/refreshments/ meal | Give away cash/ monetary rebates |
Open link below for more specific information and rules:
Sales/Marketing events are designed to steer or attempt to steer members or consumers toward a specific plan or a limited set of plans or for plan-specific retention activities.
Sales/Marketing Events must be filed with CMS no less than 7 calendar days prior to the date of the event for formal and informal events. (not one-on-one appointments)
Meals are NOT allowed at a Sales/Marketing Event. You may provide light snacks and refreshments provided that items could not be reasonably considered a meal.
The Medicare Communications and Marketing Guidelines (MCMG) defines 2 types of Sales/Marketing Events, Formal and Informal.
Formal: In-person on Online Presenter style, where an agent presents a specific plan from a carrier.
Informal: Booth, Kiosk or other less structured events (having a booth or table inside a retail store such as CVS, Walgreens, Walmart, etc.)
See chart below for more specific information and rules
CMS prohibits offering gifts to beneficiaries unless the gifts are of “nominal” value.
Currently, nominal is:
- No more than $15 per item or $75 in aggregate, per person, per year.
- Nominal gifts must be offered to similarly situated beneficiaries without discrimination and without regard to whether the beneficiary enrolls in a plan.
- Nominal gifts may not be in the form of cash, including cash-equivalents, or other monetary rebates.
Cash-equivalents mean:
- A general gift card that is not restricted to specific retail chains or to specific items and categories would be considered a cash equivalent (e.g. Visa gift card)
- Gift cards for retailers or online vendors that sell a wide variety of consumer products would also fall under this prohibition (e.g., Walmart and Amazon)
- A gift card that can be used for a more limited selection of items or food, would not be considered a cash equivalent (e.g. Starbucks or a Shell Gas gift card).
Medicare supplements
Technically, no, as Medicare Supplement plan Marketing Standards fall under “MACRA” (Medicare Access and CHIP Reauthorization Act as well as specific state laws where the Supplement is sold. You can see rules here:
MACRA Marketing Sales Bulletin
However, it's best practice to follow the same guidelines as you might discuss PDP plans and possible MA plans when talking to a beneficiary about their Medicare options.
Allegations
Please follow the specific instructions from the carrier. In general, this is a good guideline for what you should submit to the carrier (see Humana, Aetna examples) You may copy the template, complete it, and submit it to the carrier.
Note allegations by beneficiaries are taken seriously by the carrier. Carriers typically follow this process: (1) an allegation is made by a beneficiary directly or by a carrier support representative (2) the carrier investigates by requesting information from the agent (3) the agent responds with supporting evidence (4) the carrier determines whether the allegation is founded (5) if founded, the carrier will take corrective action, which is typically verbal or written coaching for the first founded allegation. Carriers may choose to terminate agent appointments if allegations continue to arise.
Other
No, Agents and brokers selling Medicare plans must be licensed by the state; and must be contracted, appointed and Ready to Sell (RTS) with each carrier you represent as the plan must tell the state which agents are selling their plans.
Typically, agents/agencies contract with a Carrier one time, but must then complete the carrier certification every year to sell plans for that year. (MA/MAPD/PDP). The requirements typically include Medicare FWA training as well as carrier-specific training.
Agents have to be ready-to-sell (RTS) with carriers to sell Medicare products for that carrier. You should receive a ready-to-sell confirmation once you’ve completed the requirements. Contact the carrier if you believe you have completed all the requirements, but have not received a confirmation notice.
A pharmacist can also be an agent; however, he/she cannot sell plans at the pharmacy counter, nor can he/she steer any customer to a plan that would require the customer to buy from his/her pharmacy.
From Humana:
A pharmacist is a healthcare provider, and so we should evaluate their exposure / access to Medicare beneficiaries the same way as we would for other health care providers and health plan agents.
I believe that the pharmacist could maintain their pharmacy license and have an active health plan agent license. However, in an abundance of caution and to reduce the appearance of a conflict of interest, the person should only be working in the capacity of one role, that is, either as a pharmacist or as a licensed health plan agent.
The main reason is because a pharmacist has access to a large database of Medicare beneficiaries who are pharmacy patients, specifically their demographic, insurance plan information, and medical / health information. The risk we are solving for is that if the pharmacist is actively working as a pharmacist and actively working as a health plan agent, the pharmacist could improperly use the pharmacy patients' database as a lead source to build their agent book of business.
If you are considering hiring this person, please make sure that the person completes the Ethics questionnaire and discloses this information.
I hope this is helpful! Please do not hesitate to reach out if you have additional questions. The Ethics Office is also available to assist via ethics@humana.com.
Please view our walkthrough here.