Agents must not assist beneficiaries in completing an AEP enrollment application. The enrollee must complete the application on their own, sign it with the current date, and mail it to the carrier using the envelope usually included in the sales kit.
How do I enroll in a Medicare plan?
Use Medicare's Plan Finder. Visit the plan's website to see if you can join online. Fill out a paper enrollment form. Contact the plan to get an enrollment form, fill it out, and return it to the plan. All plans must offer this option.
Can a Medicare agent contact potential enrollees via email?
Due to a change reflected in the 2019 Medicare Communications and Marketing Guidelines (MCMG) and now updated in CFR 42, agents are permitted to make unsolicited direct contact with potential enrollees via email. However, the email must have an opt-out option in order to remain compliant.
What is annual enrollment for Medicare Advantage plans?
Annual Enrollment is the culmination of revised CMS Medicare Advantage & Part D Communication Requirements, new 2022 plans, and all kinds of potential enrollees, some of which could be secret shoppers.
Can agents leave enrollment applications with beneficiaries during pre-AEP?
They also cannot encourage mailing, take possession of, or “just hold onto” any applications for the 2022 contract year. Agents are allowed to leave enrollment applications with a beneficiary during Pre-AEP (October 1 through October 14), but there are some stipulations that must be adhered to before AEP officially opens.
Can an agent solicit Medicare Advantage prospects through email?
The only caveat: If you are initiating contact via email, you're required to include an opt-out opportunity. Direct unsolicited contact, such as text and direct messaging over social media, falls into the same category as unsolicited phone calls and door-to-door solicitation. This means it is not permitted.
Can a Medicare agent ask for referrals?
As a Medicare sales agent, you can ask for referrals, but you cannot collect phone numbers. Instead, you can ask your clients to refer you to their family members and friends. Just give your original client a few of your business cards and tell them that anyone who they meet and needs help, can contact you.
What is not considered unsolicited contact with a Medicare eligible consumer?
If you have not received prior permission to contact, you cannot partake in the following types of marketing tactics: Do Not engage in door-to-door solicitations. Do Not engage in telephone solicitations, including voice mails or text messages. Do Not approach and solicit Medicare Beneficiaries in common/ public areas.
What are the rules for Medicare?
Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Medicare has two parts, Part A (Hospital Insurance) and Part B (Medicare Insurance).
When marketing Medicare Advantage plans What must an agent do?
Tell you where to find information about the plan (website, business cards, customer service number) Discuss different plan options. Provide and collect enrollment forms if you have the right to enroll.
When marketing Medicare Advantage plans to consumers what must an agent do?
When marketing UnitedHealthcare Medicare Advantage plans to consumers, which of the following must an agent do? Review and complete an SOA form with each consumer after a personal/individual (e.g., in-home or telephonic) marketing appointment.
In what product should Agents enroll consumers?
In what product should agents enroll consumers? A product that is suitable for the consumer's needs, goals and financial resources.
Which of the individuals below would not likely have the authority to enroll a consumer in a Medicare Advantage plan?
Which of the individuals below would not likely have the authority to enroll a consumer in a Medicare Advantage Plan? The consumer's spouse, who is neither a Power of Attorney or legal guardian.
Which of the following must you not do when marketing UnitedHealthcare Medicare Advantage?
As an agent, you must not do which of the following when marketing UnitedHealthcare Medicare Advantage plans to consumers? Use providers or provider groups to distribute printed information comparing benefits of different health plans without approval.
Why do doctors not like Medicare Advantage plans?
If they don't say under budget, they end up losing money. Meaning, you may not receive the full extent of care. Thus, many doctors will likely tell you they do not like Medicare Advantage plans because private insurance companies make it difficult for them to get paid for their services.
What does CMS guidelines stand for?
Centers for Medicare & Medicaid ServicesThe Centers for Medicare & Medicaid Services, CMS, is part of the Department of Health and Human Services (HHS).
What does CMS mandate mean?
Since we first explained the CMS vaccine mandate (the Interim Final Rule (IFR) from the Centers from Medicare & Medicaid Services (CMS) that requires COVID-19 vaccinations for all staff at covered facilities), the mandate has survived numerous legal challenges and is being implemented across the country.
Does Medicare cover all drugs?
If your doctor accepts Medicare, she accepts this plan. There are no limits on services. We cover all drugs and have no formulary restrictions. If you don’t like this plan, you can stop paying your premium and return to original Medicare anytime. It is better to choose a different company if you are sick.
Do all Medicare representatives have to take yearly training?
All representatives must take yearly training and pass tests to confirm their knowledge of the do’s and don’ts of selling MA and PDP products. All of the rules help promote a stress free environment for the Medicare beneficiary to make the right decision for his or her situation. Medicare Options.
When is the best time to enroll in Medicare?
The best time to enroll in Medicare is during your Medicare Initial Enrollment Period. For most people, this seven month period begins three months before your 65th birthday, includes your birthday month, and ends three months after your 65th birthday.
Can you compare Medicare plans?
When you speak with an agent, you can compare plans from a number of different insurance providers. Some of the Medicare plan options that may be available to you can include:
Key takeaways
An agent or broker will need information about you and your providers to help you choose a Medicare plan.
What information does an agent or broker need to help me enroll in Medicare?
An agent or broker can help you with the process of selecting a plan and completing the enrollment. In order to best assist you, they will need to know the names and dosages of any medications you take, as well as your preferred pharmacies, so that they can narrow down the options based on how your medications will be covered.
Can a friend or family member help me sign up for Medicare?
You always have the right to have a trusted friend or family member present while you’re discussing your health coverage needs with Medicare, your state’s Medicare SHIP, or with an agent or broker.
How can I authorize Medicare to discuss my coverage with someone else?
If you want Medicare to be able to directly share your personal health information with someone else, there’s an authorization form that you’ll need to complete. Once you have it on file with Medicare, you can add names to it or update it through your MyMedicare.gov account.
Can someone help me sign up for Medicare if I'm incapacitated?
If you’re incapacitated and unable to participate in your own plan selection process, someone else can act on your behalf as long as you’ve created a power of attorney (POA) and named that person as your legal representative.
Can a friend or family talk about my coverage with a private Medicare insurance company?
If you’re enrolled in a private Medicare plan (a Part D plan, a Medicare Advantage plan, or a Medigap plan ), the insurance company will have their own disclosure authorization form that you’ll need to complete so that they can discuss your coverage with a loved one.
Important Medicare Guidelines Update
Permission to Contact
- Every interaction with a potential client has a starting point. Due to a change reflected in the 2019 MCMG and now in the Medicare Advantage & Part D Communication Requirements, agents are permitted to make unsolicited direct contact with potential enrollees via email. However, the email must have an opt-out option in order to remain compliant. Add...
Scope of Appointment
- Scope of Appointment means just what it says. It’s a form outlining exactly what you’ll be presenting to a client during a meeting. The SOA ensures that potential enrollees will not be pitched plans other than those they originally requested. In 2018, the Centers for Medicare and Medicaid Services (CMS) removed the requirement for SOAs to be recorded 48 hours in advanc…
Marketing Rules
- CMS also regulates marketing and plan presentations, including when you’re allowed to market, and how you market. Agents must wait until October 1 to begin marketing next year’s plans to potential beneficiaries and cannot enroll members until October 15. In the CMS MA & Part D Communication Requirements, CMS differentiates between materials that are considered “non-…
Events & Appointments
- The types of presentations you host throughout the year typically fall under one of three categories; educational events, sales events, and individual appointments. Educational events must be advertised as such and be designed to inform Medicare beneficiaries about the parts of Medicare in general. When holding an educational event, you: MAY: 1. Distribute educational ma…
Secret Shoppers
- Staying compliant should be a year-long objective for every agent. Annual Enrollment is the culmination of revised CMS Medicare Advantage & Part D Communication Requirements, new 2022 plans, and all kinds of potential enrollees, some of which could be secret shoppers. CMS secret shoppers measure quality of service and compliance with Medicare regulations as a way …
Websites
- Consumer-facing websites that promote a specific carrier or a group of carriers’ Medicare Advantage or Part D products must be submitted to CMS for approval. This is typically accomplished through the carriers. You may refer to the specific carrier’s policy regarding website review. CMS has increasingly cracked down on websites in recent years, so it’s important to be s…