Compliance Bulletin: Unsolicited Contact With a Beneficiary

April 21st, 2025

1 min read

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The purpose of this bulletin is to provide guidance on unsolicited contact with a beneficiary and the potential penalties for non-compliance with CMS regulations.

🚫 Unsolicited Contact is Prohibited

According to CMS’ Medicare Communications and Marketing Guidelines, marketing through unsolicited contact is strictly prohibited.

Violating CMS rules can result in serious consequences, including:

Civil monetary penalties
Criminal penalties
Exclusion from federal healthcare programs
Termination of carrier contracts

⚠️ These penalties can affect not only the individual agent but also the organization as a whole.

✅ CMS Permits the Following Forms of Unsolicited Contact:

Conventional mail and other print media (e.g., direct mail, newspaper ads)
Email, provided it includes a clear opt-out option

❌ CMS Does NOT Permit:

Door-to-door solicitation, including leaving flyers or leaflets
Approaching potential enrollees in common areas (e.g., parking lots, hallways, sidewalks, etc.)
Telephonic solicitation (including voicemails) without prior express written consent

🤔 What About a “No-Show” for a Pre-Scheduled Appointment?

If a beneficiary misses a scheduled appointment, you may leave Medicare-related information at their residence.
If a beneficiary gives permission to be contacted, it must be event-specific—not open-ended for future contact.

📝 Scope of Appointment (SOA)

A completed SOA form is NOT permission to door-knock.
If you have a valid SOA, you must schedule a follow-up appointment to conduct your sales presentation.

🔍 How This Affects You

You cannot door-knock for the purpose of discussing or selling Medicare Advantage plans.

If you are working a Turning-65 lead, the only allowable action is to:

Provide your business card
Invite the consumer to schedule an appointment

For questions or further clarification, please contact our compliance team. Stay informed, stay compliant, and protect your business.

Compliance Resources

Topics:

Medicare Advantage plans

Medicare Sales

CMS

medicare updates

Compliance

insurance sales

Compliance Bulletin: Unsolicited Contact With a Beneficiary

🚫 Unsolicited Contact is Prohibited

✅ CMS Permits the Following Forms of Unsolicited Contact:

❌ CMS Does NOT Permit:

🤔 What About a “No-Show” for a Pre-Scheduled Appointment?

📝 Scope of Appointment (SOA)

🔍 How This Affects You

Compliance Resources

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