Medicare, ACA, and Life Insurance News

Compliance Bulletin: Unsolicited Contact With a Beneficiary

Written by www.psmbrokerage.com Admin | Mon, Apr 21, 2025 @ 05:50 PM

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