Consulting Fees on Non-Commissionable Plans: What Insurance Agents Need to Know

As an insurance agent selling Medicare plans, staying informed about compliance and best practices is critical to your success. This includes understanding the specific rules surrounding consultations for non-commissionable plans. These regulations, established by CMS, ensure ethical interactions and protect beneficiaries during the sales process.

Let’s break down what you need to know to stay compliant and maintain trust with your clients.

What Agents Can Do During Medicare Meetings

When meeting with Medicare beneficiaries, agents are allowed to perform the following activities:

• Distribute Plan Materials: You can provide brochures, flyers, and other documents to help clients understand the features and benefits of available plans.
• Explain Plan Options: Agents are encouraged to educate clients about their Medicare options, helping them make well-informed decisions.
• Provide Enrollment Forms: If the client is ready to enroll, you can give them the required forms.
• Collect Completed Enrollment Forms: If the client has decided to join a plan, you can accept and submit their enrollment form.
• Leave Contact Information: You can leave business cards with clients for future contact or to share with friends or family who may also need assistance.

These actions ensure you can guide clients while empowering them to make decisions at their own pace.

What Agents Can’t Do During Medicare Meetings

It’s equally important to know what you must avoid during these interactions. The following actions are strictly prohibited:

• Charging Enrollment Fees: Agents cannot charge fees for processing enrollment into a Medicare plan.
• Steering Clients: You must not push clients toward specific plans or present any single plan as “the best” or the only option.
• Providing Misleading Information: Statements like “this is the highest-ranked plan” or exaggerating plan benefits are against CMS regulations.
• Discussing Unapproved Plans: Unless clients specifically ask about additional options, you are limited to discussing plans agreed upon at the start of the meeting. A new appointment form must be completed to expand the discussion.
• Applying Pressure to Join: Avoid creating urgency by saying things like, “You need to join this plan now, or you’ll lose coverage next year.”
• Requesting Referrals Unethically: Asking clients for contact details of friends or family for sales purposes is not allowed.
• Pressuring Clients to Sign: Clients should never feel rushed to sign an enrollment form before they are ready.

Understanding and adhering to these rules ensures that you maintain ethical practices and build lasting trust with your clients.

Why This Matters for Agents

As agents, compliance protects your reputation and ensures your interactions are client-focused. These guidelines are designed to build trust, maintain professionalism, and safeguard the beneficiary’s ability to make informed choices. Staying compliant also reduces your risk of penalties or investigations, letting you focus on growing your business and providing excellent service.

Best Practices for Successful, Compliant Interactions

• Educate, Don’t Sell: Present all relevant information in a clear and unbiased way. Your role is to guide, not pressure.
• Stick to the Scope: Only discuss plans and topics agreed upon during the appointment. If a client wants to explore other options, schedule a follow-up meeting.
• Document Everything: Maintain thorough records of your interactions, including any signed forms or written consents.
• Review CMS Updates Regularly: Stay on top of regulatory changes to ensure you’re always operating within the rules.

Your Partner in Compliance and Success

At PSM Brokerage, we understand the challenges agents face when navigating Medicare rules and regulations. That’s why we provide the tools, resources, and support you need to stay compliant while growing your business. With our guidance, you can confidently assist clients and maintain the highest standards of professionalism.

Need help staying ahead in the Medicare market? Reach out today to learn how PSM Brokerage can support your journey to success!

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