Things Agents Cannot Say While Selling Medicare Plans

Published on November 2, 2021

When working with Medicare beneficiaries, it is essential to be aware that certain phrases are off-limits. Photo by Kristina Flour on Unsplash.

CMS—the Centers for Medicare and Medicaid Service—has long been concerned with protecting Medicare beneficiaries. CMS issues a list of guidelines Medicare sales agents must follow. The guidelines emphasize providing clear, factual information and avoiding actions or phrases that could be easily misinterpreted. The guidelines emphasize providing clear, factual information and avoiding actions or phrases that a beneficiary could easily misinterpret.

Anyone selling Medicare-related products is required to know and comply with all of the CMS guidelines. This article only touches on a few of many rules, and should not be considered exhaustive. Read the entire documents for Medicare Advantage and Medicare Part D communications guidelines before your first appointment.

Continue reading to learn about seven common phrases agents cannot use when selling to Medicare beneficiaries.

“I am a Medicare agent.”

Agents selling Medicare-related products like Medicare Advantage or Medicare Part D cannot give clients the impression that they work for Medicare or that Medicare endorses their plans. In addition to conversation, agents are prohibited from implying that they work for Medicare or CMS on any promotional or written material. Instead, you should explicitly state that you are an independent contractor.

“This plan is free.”

Claiming that any plan is “free” is off-limits for an agent selling Medicare products. While many Medicare Advantage plans have a zero-dollar monthly premium, describing them as “free” gives the impression that it is free to use the plan and there will be no charges for services, which is incorrect. Beneficiaries interested in these plans should understand that even though they will not pay a monthly premium, they will pay for services with copayments, coinsurance, and a deductible.

“I can accept your premium payment over the phone if you are ready to enroll.”

It is prohibited for Medicare agents to take or request premium payments by phone. Rather, all enrollees must receive a paper bill in the mail.

“Can I have the phone numbers of your friends and family who may be interested?”

While referrals are vital for any agent, those selling Medicare products cannot request or collect phone numbers for potential prospects. Instead, ask your client to pass along your business card to anyone who may need help with their plan.

“This is the best plan on the market.”

CMS guidelines forbid the use of superlatives. Any claim that a plan is the “best,” “greatest,” “number 1”, etc. should not be used. This provision is designed to keep seniors from receiving misleading information via unproven claims or claims that are confusing or inaccurate. Instead, agents should focus on educating clients with facts about how the plan will work for them.

“Enroll now to receive this free gift!”

Medicare sales agents are not allowed to give gifts of any kind in exchange for enrollments.

“Do you also want to buy life insurance today?”

For Medicare sales appointments, agents must follow the predetermined scope of appointment. A scope of appointment has a list of plan types, and the client can check them off if they want information about that plan. Occasionally, a client may ask about a plan type they did not select. In those cases, the beneficiary must fill out a new SOA before the agent can discuss that plan type with them. Only health-related plans are eligible to be discussed during a Medicare appointment, so topics like life insurance or annuities can never be discussed in a Medicare appointment.

Final Thoughts

For new agents, the strict regulations around Medicare can be intimidating. Be sure to get guidance from your sales leader or a seasoned agent and have them shadow you on your first sale to make sure everything in your pitch meets the guidelines. While CMS rules for agents may complicate sales a little, the rules are there to defend seniors against predatory salespeople. By following the regulations, we can help protect this vulnerable population.

How Do I Learn More?

To learn more about how to sell Medicare plans, contact American Senior Benefits. Their affiliated agents are experienced and can help you with any of your questions.

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