Agent Compliance Guide: Staying Compliant Before the Sale

November 2nd, 2023

1 min read

Compliance with rules for selling Medicare Advantage (MA) and Part D prescription drug plans (PDP) is the responsibility of everyone serving Medicare customers. This guide was developed to aid compliance throughout all stages of the sales process and includes critical information and useful tips to keep in mind at all times.

Making a Compliant MA/PDP Presentation

Featuring a handy check list, presentation phases are covered in three sections:

1.) Prior – Key points

Understanding what is permissible and not permissible to discuss with a prospective client
Knowing what questions to ask
Being prepared to sell

2.) During – Necessary steps

Making proper introductions
Providing necessary disclosures
Being up-to-date on relevant published materials such as provider networks, drug formularies and plan benefits, premiums and client costs
Ensuring clients understand all aspects of the sales process

3.) After – Important follow-up actions

Seeing if the customer has any questions about the plan they’ve chosen
Confirming client understanding of benefits, coverages, co-pays/co-insurance and provider network information
Making sure the customer has the agent’s contact information

Things to Know

Do

Clearly identify the products to be discussed, and ONLY discuss those agreed upon in the Scope of Appointment (SOA)
Announce you don’t work for Medicare and that you could be compensated for a sale
Quote accurate rates
Hold meetings in handicapped-accessible facilities
Communicate to non-English speakers in a way they will understand
Advise clients how to use a formulary
Use only materials that meet CMS requirements
Complete enrollment forms ONLY for those who are unable to do so themselves

Do Not

Discriminate in any way, including discouraging enrollment for the disabled
Attempt to enroll someone with a diminished capacity to understand
Engage in high-pressure sales or scare tactics or use misleading, conflicting, confusing statements
Collect financial information during pre-enrollment activities
Imply Medicare is only available to seniors
Offer monetary or promotional gifts to induce enrollment or to compensate based on use of services

Other Points of Interest

In addition to the preceding information, the compliance guide addresses the following topics:

Compliance metrics
Avoiding client complaints
Primary care physician auto-assignments
Marketing during Pre-AEP and prior to October 1
Do’s and don’ts for conducting an educational event
And more

Download the Compliance Guide here

Topics:

Medicare Advantage

Medicare Part D

Compliance

Agent Compliance Guide: Staying Compliant Before the Sale

Making a Compliant MA/PDP Presentation

1.) Prior – Key points

2.) During – Necessary steps

3.) After – Important follow-up actions

Things to Know

Do

Do Not

Other Points of Interest

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