| PROHIBITED AGENT/BROKER BEHAVIOR | APPROPRIATE AGENT/BROKER BEHAVIOR |
| Can’t state that they are from Medicare or use “Medicare” in a misleading manner. For example, they can’t state that they are endorsed by Medicare, are calling on behalf of Medicare, or that Medicare asked them to call or see the beneficiary | May call someone with Medicare who has expressly given permission. The permission applies only to the plan or agent/broker the person that requested contact from, for the duration of that transaction, and for the scope of products |
| Can’t solicit potential enrollees door-to-door | Can call their own clients to discuss new plan options |
| Can’t send unwanted emails, text messages, or leave voicemails | May call or visit someone with Medicare who attended a sales event if the person gave permission |
| Can’t approach people with Medicare in common areas (i.e. parking lots, hallways, lobbies, sidewalks) | May initiate a phone call to confirm an appointment. Scope of the appointment may be changed with appropriate documentation |
| Can’t conduct sales activities in healthcare settings except in common areas. Improper areas include waiting rooms, exam rooms, hospital patient rooms, dialysis centers and pharmacy counter areas | Can conduct sales activities in common areas of healthcare settings. Appropriate common areas include hospital or nursing home cafeterias, community or recreational rooms, and conference rooms |
| Can’t make unwanted calls, including contacting people with Medicare under the guise of selling a non-Medicare Advantage (MA) or non-Prescription Drug Plan (PDP) product and allow the conversation to turn to MA or PDP. For example, an agent/broker can’t begin by selling a Medicare Supplement plan and then turn the conversation to MA or PDP products | Must secure a signed “scope of appointment”, prior to the appointment. For example, provided that the person has completed the scope of appointment form following a marketing/sales event, the future appointment may take place immediately after marketing/sales meeting |
| Can’t provide meals to potential enrollees at sales presentation | May provide refreshments and light snacks to potential enrollees at sales presentations |
| Can’t conduct marketing or sales activities at an educational event (such as discuss plan benefits) | May schedule appointments with people who live in long term care facilities only upon request |
| Can’t market non-health related products (such as annuities and life insurance) to potential enrollees during MA or PDP sales activities or presentations | May leave cards behind for clients to give to their friend or family. The “referred” person has to contact the agent/broker directly |
| Can’t offer gifts to potential enrollees of more than $15. If a gift is offered it must be made available to all potential enrollees even if they do not enroll in a plan | May make sales presentations to groups of people without documenting scope of appointment with each individual since such documentation is only required for personal/individual sales events |
To report concerns or specific complaints about possible inappropriate marketing practices, contact your State Health Insurance Assistance Program (SHIP).
Call 1-800-MEDICARE or go to www.medicare.gov to get the phone number for your local SHIP. You can also send an email with details to surveillance@cms.hhs.gov.