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).
New 2027 CMS Final Rule Effective June 1, 2026: The TPMO disclaimer remains required, but CMS revised the timing for sales calls. Instead of requiring the verbal disclaimer within the first minute of the call, the disclaimer must now be verbally conveyed before any discussion of benefits.
CMS rule citation: 42 C.F.R. §§ 422.2267(e)(41), 423.2267(e)(41); CY 2027 Final Rule, 91 Fed. Reg. 17448-17450, 17583, 17592.
- 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.
New 2027 CMS Final Rule Effective June 1, 2026: The final rule states that all marketing and sales calls, including the audio portion of calls conducted through web-based technology, must be recorded and retained in their entirety for a minimum of 6 years.
For the first 3 years, the record must be maintained in audio format. For years 4, 5, and 6, the record may be maintained either as audio or as a complete and accurate transcript. Enrollment records remain subject to separate 10-year retention requirements.
CMS rule citation: 42 C.F.R. §§ 422.2274(g)(2)(ii), 423.2274(g)(2)(ii); CY 2027 Final Rule, 91 Fed. Reg. 17464-17468, 17583, 17592. Enrollment record retention remains tied to 42 C.F.R. §§ 422.60(c)(2), 422.504(e)(1)(iv), and 423.505(e)(1)(iv).
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.
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.
New 2027 CMS Final Rule Effective June 1, 2026: Agents are no longer required to wait 48 hours after completing a Scope of Appointment before conducting a personal marketing appointment. A beneficiary may complete an SOA and then proceed to a plan-specific discussion during the same call, meeting, or day, provided the SOA is completed before the personal marketing appointment begins.
CMS rule citation: 42 C.F.R. §§ 422.2264(c)(3)(i), 423.2264(c)(3)(i); CY 2027 Final Rule, 91 Fed. Reg. 17455-17459, 17583, 17592.
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.
New 2027 CMS Final Rule Effective June 1, 2026: Superlatives in Marketing Materials: More Flexibility, But Claims Must Still Be Accurate
CMS also relaxed the prior restrictions on using superlative language in Medicare marketing and communications materials. Terms such as “best,” “most,” “highest rated,” “top-rated,” “largest,” or similar wording may now be used, provided the statement is truthful, factually supportable when applicable, and not misleading, confusing, or materially inaccurate.
This does not mean agents may make exaggerated or unsupported claims. If a superlative can be measured or verified, such as “largest provider network,” “highest rated plan,” or “most comprehensive dental benefit,” the statement must be supportable through reliable data, reports, studies, surveys, or other appropriate documentation. CMS may still request supporting documentation during material review or as part of a complaint investigation.
CMS removed the prior requirement that supporting documentation or data be referenced directly in the marketing material itself. However, agents and organizations should still be prepared to substantiate any claim if asked by CMS, a carrier, or FutureCare Compliance.
Important agent reminder: Do not use superlatives in a way that could mislead a beneficiary. For example, saying a plan has the “best benefits” may be problematic if the statement is subjective and depends on the beneficiary’s individual health needs, provider preferences, prescriptions, or financial situation. When in doubt, use clear, specific, and supportable language.
CMS Rule Citation: 42 C.F.R. §§ 422.2262(a)(1)(i), 422.2262(a)(1)(ii), 423.2262(a)(1)(i), and 423.2262(a)(1)(ii); CY 2027 Final Rule, 91 Fed. Reg. 17461–17463. CMS finalized removal of the specific superlative restriction and the requirement to reference supporting
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.
New 2027 CMS Final Rule Effective June 1, 2026: CMS now permits plans and agents or brokers participating in educational events to make available and receive Scope of Appointment forms at those events. CMS clarified that collecting an SOA is not, by itself, a sales or marketing activity. However, the educational event itself must remain educational.
CMS rule citation: 42 C.F.R. §§ 422.2264(c)(1)(ii)(D), 423.2264(c)(1)(ii)(D); CY 2027 Final Rule, 91 Fed. Reg. 17459-17460, 17583, 17592.
New 2027 CMS Final Rule Effective June 1, 2026: CMS removed the prior 12-hour separation requirement between an educational event and a marketing or sales event held in the same location. This means an educational event may now transition into a marketing event on the same day and in the same location, but only if the transition is handled clearly and compliantly.
Agents must clearly tell attendees when the educational event is ending and that a marketing event is about to begin. Attendees must be given a genuine opportunity to leave before the marketing event starts. A brief break, such as a restroom or refreshment break, may satisfy this requirement if it gives beneficiaries a clear chance to exit without pressure.
What Has Not Changed
The CY 2027 rule provides more flexibility, but it does not remove core compliance obligations. Agents must continue to:
- Maintain a valid SOA before discussing plan-specific options.
- Avoid misleading, confusing, or materially inaccurate statements.
- Avoid pressure tactics or steering.
- Follow approved scripts, carrier rules, and FutureCare compliance guidance.
- Respect beneficiary requests to stop contact.
- Follow TCPA and Do-Not-Call requirements.
CMS rule citation: 42 C.F.R. §§ 422.2262, 423.2262, 422.2274(g)(1), 423.2274(g)(1); CY 2027 Final Rule, 91 Fed. Reg. 17461-17463.
TCPA reminder: CMS flexibility does not override the Telephone Consumer Protection Act or FCC telemarketing rules. Agents must continue to follow applicable consent, calling, texting, and opt-out requirements under 47 U.S.C. § 227 and 47 C.F.R. § 64.1200.
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 2026 CMS Final Rule
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