6 Medicare Compliance Concerns To Avoid

Top Medicare Compliance Concerns To Avoid | Senior Market Advisors

6 Medicare Compliance Concerns To Avoid

You can’t sell effectively if you don’t follow Medicare compliance rules! In fact, if you don’t follow the rules, you won’t be able to sell at all. Breaking CMS compliance guidelines can result in a revoked insurance license, heavy fines, and even jail time for serious offenses. These are the top Medicare compliance concerns that you should keep at the front of your mind at all times.

1. Ignoring Carrier Guidelines

While we’re sure you’ve looked over the Centers for Medicare and Medicaid Services (CMS) compliance guidelines, have you checked carrier compliance rules? That’s right – you have to follow all CMS rules first, but you also have to look for carrier-specific rules and regulations. Make sure you are 100% familiar with the products you are selling and the rules that surround them before you get into the field.

2. Using the Word Free and Being Misleading

It’s not only frowned upon, but highly non-compliant for you to mislead or misinform your clients when selling Medicare. You may often mislead by accident just from a lack of understanding. For example, you cannot say “I can find you savings” because it’s possible that there aren’t any savings available for that client. You should instead say, “I may be able to find you savings” until you are sure.

One of the  biggest ways you can accidentally break this rule is by using the word “free” or “no premium.” Instead, always use “$0.” Implying that something is free can open you up to problems when the client realizes that there are copayments, deductibles, and other charges. Even the phrase “premium-free” can be misleading, because even though they may not owe a premium for their Medicare Advantage plan, they still have to pay their Part B premiums. Therefore, they are technically not “premium-free.” Instead, say that the plan has a $0 premium.

3. Cross-Selling

Let’s say you have a perfect appointment, the client agrees to enroll in a Medicare Advantage plan, and you’re wrapping up the application. The client is in a good mood and you think you can swing a life insurance sale at the same appointment. Unfortunately, you can’t. When selling Medicare Advantage, you can only sell what was agreed upon in the Scope of Appointment sheet, which doesn’t give you the option to sell life or other products.

4. Offering Incentives and “Gifts”

You can never offer gifts in exchange for plan enrollment.

You can give nominal gifts at events (less than $15 per event and no more than $75 per person, per year), for example, a $5 gift card for attending an educational seminar, or a raffle prize valued at $15.

5. Saying you Work for Medicare

You can never call yourself a “Medicare agent,” say that you work for Medicare, or otherwise imply that you are endorsed by the government. You can call yourself a “licensed insurance agent who offers Medicare Advantage plans.”

6. Distributing Unapproved Marketing Materials

CMS and individual carriers have their own sets of rules regarding Medicare flyers, business cards, postcards, emails, etc. From required font size to disclaimers, any missed detail can cost you your insurance license. Make sure you read up on Medicare marketing compliance before designing your own materials.

If you’re going to use a carrier name, you absolutely have to have their permission before you can distribute your materials.

Alternatively, you can use our pre-approved marketing materials if you contract with Senior Market Advisors! We have a full online store where our agents can get customized marketing materials that are pre-approved by our compliance department. You won’t have to worry about compliance or spend the time designing your own materials. Interested? Get in touch with us by web or phone at 1-844-452-5020.

Anastasia Iliou
Anastasia Iliou
Senior Content Manager at Senior Market Advisors
Anastasia graduated from Belmont University with a Bachelor's degree in Songwriting. When she's not writing, she's on a mission to visit all 50 states in the U.S (and to date has reached 43). Anastasia loves writing music, hiking, and playing with her pets (hedgehog, dog, and two cats). She loves animals (but not so much bugs) and spends her free time volunteering for The Elephant Sanctuary in Tennesee.