10 Compliance Mistakes to Avoid When Selling Medicare Advantage Plans

There are a lot of “C’s” involved in selling Medicare products: from contracting to certifications to creating marketing communications for current and prospective clients. One of the most important “C’s” is Compliance because being attentive to this aspect of the business ensures you make and retain your renewal income. Adhering to compliance standards doesn’t have to be as daunting as it may appear, and a clear understanding of the basics is easy to integrate into your everyday activities.

An actively involved National Marketing Organization (NMO) can provide guidance and assist you or your agency with staying compliant through training, oversight, and reviewing or creating marketing materials that meet Centers for Medicare and Medicaid Services (CMS) guidelines. While this can be an incredibly helpful resource, it’s important to know CMS and individual carriers hold the agent responsible for compliance – from the point of first contact through the entire enrollment process. Any repercussions that occur as a result of non-compliance land squarely on the agent, regardless of whether he or she deliberately committed a violation or were simply unaware of the rules in place.

This article isn’t meant to be a comprehensive overview of every CMS and carrier-specific compliance guideline. It is, however, a great place to start to ensure you avoid the 10 most common compliance mistakes agents make when selling Medicare Advantage plans:

1. Failing to obtain Permission to Contact (PTC). Agents must obtain Permission to Contact prior to marketing Medicare Advantage or Prescription Drug Plans.

2. Failing to secure a Scope of Appointment (SOA). This form is mandatory prior to a scheduled meeting and outlines exactly what you’ll be presenting to the enrollee.

3. Offering money or gift cards in any amount. Simply don’t do this.

4. Offering gifts worth more than $15 retail value (that aren’t available to the general public) in order to encourage enrollment.

5. Marketing or selling non-healthcare related products (ie. annuities, investments etc.). You cannot market non-health products in a Medicare appointment. This is considered cross-selling and it is prohibited.102

6. Discussing and/or marketing healthcare products beyond what th9-6\][poiuytatyuioe beneficiary originally agreed to discuss.

7. Cold calling under the guise of selling other products and then guiding the conversation to Medicare Advantage plans. This is considered bait and switch.

8. Going into housing/condo/apartment complexes or communities without appointments and attempting door-to-door sales.

9. Failing to report events to carriers. If you’re conducting a marketing sales event, you must report it to all of the carriers you are representing at that event.

10. Implying you are calling or selling on behalf of Medicare. Your presentations and marketing materials must communicate clearly that you don’t represent Medicare.

At the end of the day, no one wants a compliance violation. And while guidelines are ever-changing and updated often, a basic understanding of the rules can go a long way to ensuring you don’t get flagged. Whenever there’s any doubt as to whether you are or are not within compliance, check with your upline and/or NMO. We’re here to help!

As a National Marketing Organization that works with thousands of independent agents, we understand you must compliantly generate new leads in order to grow your business. That’s why we work diligently to provide the resources necessary for successful marketing. If this information is valuable and you want to know more about the services we provide our agent partners, please contact us at marketing@berwickinsurance.com or call 888-745-2320.

Important: the information provided is current and accurate to the best of our ability at the time of posting. Compliance standards change often, and we advise regularly checking with your NMO partner to ensure you’re conducting business within current state and national compliance guidelines.

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