Guidelines on Medicare Communications and Marketing
Before discussing specific do’s and don’ts, it is important to reference the full Medicare Communications and Marketing Guidelines (MCMG), available on CMS.gov. For more detailed information, the Medicare Advantage and Part D Communication Requirements can be accessed on the Federal Register site, which is user friendly and accessible for reviewing the latest Medicare marketing guidelines and updates.
Third Party Marketing Organization (TPMO) Guidelines
The Centers for Medicare & Medicaid Services (CMS) classify agents and brokers as third party marketing organizations (TPMOs). As such, they must adhere to specific rules when marketing Medicare Advantage or Prescription Drug plans, including:
- Disclosure Requirements:
Disclose to health plans or FutureCare any subcontracted relationships used for marketing, lead generation, and enrollment.
Report monthly to the carrier(s) or FutureCare any staff disciplinary actions or violations of requirements related to beneficiary interactions with Medicare Advantage or Part D plans.
- TPMO Disclaimer:
Use the standardized TPMO disclaimer verbatim in email communications, websites, print materials, and within the first minute of sales calls, as required under § 422.2267(e)(41) and § 423.2267(e)(41).
- Call Recording:
Record all sales, enrollment, and marketing calls (including video calls) with beneficiaries in their entirety. According to the CMS 2024 Final Rule, recording is limited to marketing, sales, and enrollment calls.
TPMO Disclaimer Text
For marketing fewer than all plans within a service area: “We do not offer every plan available in your area. Currently, we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. Please contact Medicare.gov, 1800MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.”
For marketing all plans within a service area:
“Currently, we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. You can always contact Medicare.gov, 1800MEDICARE, or your local State Health Insurance Program (SHIP) for help with plan choices.”
This disclaimer must be present in electronic communications with beneficiaries, including email, online chat, or other electronic means.
Call Recording
Agents and brokers must record all interactions related to sales, marketing (including retention marketing), and enrollment calls (both inbound and outbound) entirely. This includes introductory calls, enrollment discussions, and post enrollment communications. In-person meetings do not require recording.
Permission to Contact (PTC)
Agents may make unsolicited direct contact with potential enrollees via email, provided the email includes an optout option and does not steer recipients toward specific plans.
Unsolicited phone calls or door to door visits remain prohibited.
To initiate contact, agents should obtain PTC using business reply cards (BRCs) or flyers, ensuring these comply with regulatory requirements. PTC and BRCs are valid for 12 months or until their purpose has been fulfilled. It is important to note that lead generation entities are considered TPMOs and must comply with specific requirements, including disclosing relationships and activities to beneficiaries.
Scope of Appointment (SOA)
An SOA form is required for every Medicare sales appointment, outlining the topics to be discussed. SOA forms must be retained for at least 10 years, regardless of whether a sale occurs. Agents must wait 48 hours after obtaining an SOA before holding an appointment, with certain exceptions for endofenrollment periods or unscheduled inperson meetings.
Marketing Rules
CMS regulates both marketing and plan presentations, dictating when and how marketing can occur. Marketing for the upcoming year begins on October 1, and enrollments cannot be processed before October 15. Agents must differentiate between marketing and nonmarketing materials and adhere to CMS’s definitions and guidelines. All marketing materials, especially those mentioning benefits like dental, vision, or hearing, require CMS review and approval before use.
Agents must avoid using absolutes, superlatives, or misleading terms like “free” when describing plans and benefits. Transparency is crucial, including disclosing star ratings and the presence of a Low Performing Icon (LPI) if applicable.
Events & Appointments
Events are categorized as educational or sales. Educational events must provide general Medicare information without discussing specific plans or collecting SOAs. Sales events can focus on specific plans, but agents must follow strict guidelines, including optional signin sheets and the prohibition of certain activities like health screenings or offering meals.
Websites
Websites promoting specific Medicare Advantage or Part D products must be submitted to CMS for approval through the relevant carriers. It is essential to ensure compliance with CMS’s guidelines for online content.
For detailed compliance, agents should regularly consult the CMS guidelines and work closely with carriers and regulatory bodies.
Link to the Dos and Donts of Medicare Marketing https://www.cms.gov/files/document/agentbroker-dos-donts-9-2021.pdf
Link to the CMS Medicare communication and Marketing Guidelines
https://www.cms.gov/medicare/health-drug-plans/managed-care-marketing/medicare-guidelines
Link to the 2025 CMS Final Rule
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