Compliant Communicating w/ Medicare Eligible’s

Created

Mar 20, 2025 5:58 PM

Absolutely not allowed

Organizations/Agents/Agency cannot make unsolicited phone calls, home visits uninvited or engage in other forms of unsolicited outreach

All scripts must clarify either within a single script or by separating out two distinct scripts, what specifically is being said by licensed sales agents and what is being said by non-licensed representatives.
Agent’s Role: Call scripts must clearly identify at the beginning of the conversation whether the agent is a licensed sales agent or non-licensed representative.
Non-licensed representatives may only conduct activities as permitted by state law. State law determines activities that require a licensed agent/broker. Unless required by state law, the following do not require the use of state-licensed marketing representatives: o Providing factual information o Fulfilling a request for materials; or o Taking demographic information in order to complete an enrollment application.
To ensure beneficiaries are not mislead or confused, licensed agents/brokers who are customer service representatives cannot act simultaneously as both a customer service representative and a sales/marketing agent/broker. The agent/broker must clearly state to the beneficiary when their role changes to a marketing/sales role.

Obtain Explicit Permission

Before engaging in direct communication (phone calls, emails, etc.)- you must obtain explicit permission from the beneficiary to be contacted
General Unsolicited Emails may be sent out without PTC but they MUST have an opt-out option(sometimes it’s easier/less stress to just not do these)
Ensure that PTC is documented and readily available for review
PTC is valid for 12 months only
Beneficiaries have the ability to revoke their permission to be contacted at any time
Beneficiaries have the right to only allow certain forms of contact

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)