What Are CMS’ Guidelines for One-on-One Appointments?


CMS has guidelines for almost every Medicare interaction you may have in your professional career. That includes one-on-one appointments. Excelsior has broken down the one-on-one appointment guidelines (MCMG, Sections 40.7, 50.3, and 110.2) into three basic rules:

  1. Follow the Scope of Appointment (SOA).
  2. Don’t market nonhealthcare-related products.
  3. Don’t ask for/agree to complete an enrollment before AEP.

Rule 1: Follow the Scope of Appointment.

Before a one-on-one Medicare appointment, be sure to have any current or potential beneficiaries fill out a Scope of Appointment form (SOA). It’s a CMS requirement. Additionally, CMS requires that brokers limit discussion to the products or topics that have been listed on the SOA.

If the beneficiary is curious about products or topics that are not included on the SOA form, you don’t have to end the appointment or avoid those topics. Simply ask the beneficiary to fill out a secondary SOA and continue.

Rule 2: Don’t Market Non-Healthcare-Related Insurance Products.

The guidelines also prohibit brokers from marketing non-healthcare-related products during a one-on-one appointment. Annuities and life insurance policies are examples of non-healthcare-related products.

So, if the product is not on the SOA form or a healthcare product, CMS prohibits you from marketing it during a one-on-one appointment.

Rule 3: Don’t Ask for or Agree to Complete an Enrollment Before AEP.

Brokers are prohibited from asking for or accepting enrollment applications or requests prior to the Annual Enrollment Period (AEP). In layman’s terms, that means you can’t fill out or file Medicare enrollment paperwork before October 15. Even if a beneficiary knows what products they want, you have to wait until October 15 to submit any enrollment information.

There Is One Exception to the Rule.

If a beneficiary is entitled to a Special Enrollment Period (SEP) or they are within their Initial Enrollment Period (IEP), you can fill out and file enrollment paperwork outside of AEP.

Find More Broker Guidance With Excelsior

To find more broken down Medicare Marketing Guidelines, visit Excelsior’s online resource center. If you’re more interested in learning how to double, or triple, your revenue with compliant cross-selling, contact us. Our regional sales directors are ready to help you grow your business.


EXCL000104

References
https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/Downloads/CY2019-Medicare-Communications-and-Marketing-Guidelines_Updated-090518.pdf

Read this Next

Ready to engage with Excelsior?

Contact us