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