What to Know About Medicare Walk-In Appointments & SOAs


Before you start helping an interested senior pick the best Medicare coverage for their needs, there is one form that must be filled out. The first step to any Medicare walk-in appointment must involve a documenting a Scope of Appointment (SOA) form, according to CMS guidelines (Section 70.4.4). Although an SOA isn’t needed to discuss Medicare Supplement plans, it’s a good idea to have one on file.

Why Brokers Must Document the Scope of Appointment (SOA)

Before you begin your presentation, ask your guest to fill out an SOA form. Not only is it a CMS requirement, but documenting an SOA can work in your favor.

  • An SOA will introduce the products you offer to a potential enrollee and give them a basic understanding of what can be discussed during an appointment.
  • An SOA will help you determine what to discuss (and what to avoid) during the appointment.
  • A documented and filed SOA will help you during a CMS audit.

Once the SOA is documented, you can start the appointment. CMS requires you to maintain a record of the Scope of Appointment for 10 years.

What Products Does an SOA Cover?

Brokers must document an SOA form in order to discuss the following products with a client:

  • Medicare Advantage (MA)
  • Prescription Drug Plans (PDPs)
  • Medicare-Medicaid Plan (MMP)

Keep in mind: You don’t need an SOA to talk about Medicare Supplements. However, it’s best practice to have one on file before you start the appointment. For example, if your client wants to discuss PDPs in addition to Medicare Supplements, you can continue the appointment so long as you previously obtained an SOA.

What to Do During Walk-In Appointments Before AEP

If you get a walk-in appointment before the annual enrollment period (AEP) begins October 1, you can still discuss the current year’s plan offerings with beneficiaries who are eligible for a valid enrollment. Such beneficiaries could be those aging into Medicare or those who qualify for a special enrollment period. Brokers may educate beneficiaries about supplemental coverage and Medicare parts in general, as long as it is documented on an SOA form. However, you are prohibited from discussing:

  1. Items not listed on the SOA form.
  2. Plan details for the upcoming benefit year.

For example, let’s say a woman named Susan enters your storefront and requests a walk-in appointment. Susan is turning 65 soon, and she wants to know her Medicare options.

  1. First, you are required to ask Susan to fill out an SOA form. Not only is this for your documentation, it is a CMS requirement.
  2. Then, you are free to discuss anything Susan has indicated she is interested in for the current plan year. So if the date is July 30, 2017, you can explain Susan’s 2017 plan options.

Find More Medicare Marketing Guidelines With Excelsior

You can find more Medicare Marketing Guidelines, including how to handle an SOA at marketing events, on Excelsior’s online resource center. To learn more about the Excelsior team and how we can help you, contact us.


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References
https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/Downloads/2017MedicareMarketingGuidelines2.pdf

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