Before the Annual Enrollment Period kicks off, agents are often busy contracting and completing certifications. However, agents MUST prioritize something that matters even more — Compliance.
It’s not just a seasonal task. Staying compliant should be a year-round commitment for every Medicare agent.
A Quick Note on Medicare Marketing Rules
Before diving into the do’s and don’ts, remember that the complete Medicare Communications and Marketing Guidelines (MCMG) are available on CMS.gov.
You can also review the Medicare Advantage and Part D Communication Requirements on the Federal Register website. It’s simple to use and makes it easy to stay up to date with the latest Medicare marketing rules and updates.
TPMO Guidelines
The Centers for Medicare & Medicaid Services (CMS) classify agents and brokers as Third-Party Marketing Organizations (TPMOs). As such, all agents must follow specific rules when marketing Medicare Advantage or Prescription Drug Plans.
Key TPMO Requirements
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Identify Your Partners: Maintain a list of all vendors, contractors, and subcontractors you use for marketing, lead generation, sales, or enrollment activities. Update and sign written agreements with each TPMO to ensure they comply with CMS regulations.
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Protect Beneficiary Data: Never share a beneficiary’s personal information with another TPMO unless you have their express written consent.
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Obtain Proper Consent: Before collecting or sharing beneficiary data, you must present a clear disclosure that lists each organization receiving the data. The beneficiary must be able to agree or decline individually for each TPMO.
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Disclose Subcontractors: Notify your carrier(s) and/or Ritter about any subcontracted relationships involved in marketing, lead generation, or enrollment.
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Monitor Compliance: Develop a plan to track compliance issues and report any disciplinary actions or violations monthly to your carrier(s) and/or Ritter.
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Use the Required TPMO Disclaimer: Include the proper disclaimer (outlined below) in all required materials and communications per §422.2267(e)(41) and §423.2267(e)(41).
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Record All Calls: CMS requires agents to record all marketing, sales, and enrollment calls (including video calls) in their entirety. Under the 2024 CMS Final Rule, this includes marketing and retention-related calls only.
The TPMO Disclaimer
Agents must use the official TPMO disclaimer verbatim in all emails, websites, printed materials, and within the first minute of any sales call.
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If you market fewer than all plans in your 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, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.”
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If you market all plans in your 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, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) for help with plan choices.”
This disclaimer must also appear in any electronic communication with a beneficiary (email, chat, or online message).
Other Required Disclaimers
HIPAA Compliance
The Health Insurance Portability and Accountability Act (HIPAA) sets national standards for protecting sensitive medical information. Agents, as business associates, may only use Protected Health Information (PHI) for the specific purposes permitted by the covered entity providing it.
To remain compliant:
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Do not send PHI through unsecured emails or messaging platforms.
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Avoid leaving PHI in voicemails.
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Always shred or securely dispose of any physical PHI documents.
Call Recording Requirements
Agents and brokers must record all inbound and outbound calls that involve:
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Educating or informing clients about Medicare Advantage or Part D plans
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Discussing plan options leading to an enrollment decision
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Conducting post-enrollment or retention marketing calls
Note: You do not need to record in-person meetings with beneficiaries.
Permission to Contact (PTC)
Every client relationship begins with a single point of contact. While agents may send unsolicited emails to potential Medicare beneficiaries, these emails must include an opt-out option to remain compliant.
It’s also important to remember that the content of any unsolicited email cannot directly or indirectly steer a recipient toward choosing or keeping a specific plan. A compliant message should highlight your services as an agent, not promote any particular product or carrier.
Agents are not permitted to:
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Approach potential clients in public areas (e.g., parking lots, stores, community centers)
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Make unsolicited phone calls
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Conduct door-to-door visits
Obtaining Permission to Contact
Before engaging a potential enrollee, you must obtain Permission to Contact (PTC). This can be done through lead providers, who send Business Reply Cards (BRCs) or flyers that include an optional PTC form. These materials must comply with all CMS and Telephone Consumer Protection Act (TCPA) requirements, including the proper disclaimer.
PTCs and BRCs are valid for 12 months or until their intended purpose has been fulfilled — whichever comes first.
Because lead generation companies are now classified as Third-Party Marketing Organizations (TPMOs), they must also follow CMS regulations. If you work with a third-party lead vendor, you are responsible for ensuring that they:
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Disclose all subcontracted relationships to the carrier(s) and/or Ritter, including any third-party marketing or lead generation partners.
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Develop and maintain a compliance plan, reporting any disciplinary actions or violations related to beneficiary interactions on a monthly basis to the carrier(s) and/or Ritter.
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Inform beneficiaries that their information will be shared with or transferred to a licensed insurance agent who may contact them for marketing or enrollment purposes. This disclosure must be made:
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Verbally during phone calls
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In writing through mail or printed communication
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Electronically via email, online chat, or other digital messaging platforms
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PTC vs. Scope of Appointment (SOA)
A Permission to Contact is not the same as a Scope of Appointment (SOA). The PTC allows you to initiate contact — the SOA must then be obtained before any appointment or plan discussion takes place. In most cases, the sequence is:
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Permission to Contact → 2. Scope of Appointment → 3. Appointment and Plan Discussion
Collecting Beneficiary Information
Finally, agents cannot require beneficiaries to provide personal details — such as their Medicare Beneficiary Identifier (MBI), Social Security number, or any information used for CMS eligibility queries — in order to view plan options.
The only exception is that you may request a ZIP code to determine which plans are available in their service area.
Scope of Appointment (SOA)
A Scope of Appointment (SOA) form does exactly what its name suggests — it clearly defines what topics and plan types you’re authorized to discuss with a Medicare beneficiary during a meeting. The SOA protects beneficiaries from being presented with products they did not originally agree to review.
An SOA is required for every Medicare sales appointment, whether the meeting is held in person, by phone, or virtually. According to CMS regulations, agents must retain all SOA forms for at least 10 years, even if no enrollment results from the meeting.
SOAs are valid for 12 months or until used, whichever comes first. If an SOA expires, a new one must be obtained before continuing any Medicare plan discussions.
Using and Managing SOAs
An SOA must be in place any time:
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An enrollment occurs, or
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A beneficiary chooses to end discussions or requests a follow-up conversation later.
If a client wants to revisit options after the initial meeting, the same SOA may be used for that follow-up discussion, as long as it’s still valid.
Agents are generally required to wait 48 hours between obtaining an SOA and conducting the appointment, except in these situations:
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When the beneficiary is four days or fewer away from the end of an active enrollment period (AEP, OEP, SEP, or ICEP)
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During unscheduled, beneficiary-initiated meetings (for example, a walk-in request for information)
Adjusting the Scope During a Meeting
If a client expresses interest in topics outside the original SOA during the appointment, you must pause the meeting and complete a new SOA before continuing the discussion.
If the beneficiary wishes to learn about non-health-related products (such as life insurance or annuities), you must schedule a separate appointment at a later date to review those options.
Marketing Rules and Compliance
The Centers for Medicare & Medicaid Services (CMS) strictly regulate how agents market and present Medicare Advantage and Part D plans — including when marketing can begin, how information is shared, and what content is permitted.
Agents may begin marketing next year’s plans on October 1, but cannot enroll beneficiaries until October 15, the official start of the Annual Enrollment Period (AEP).
Marketing vs. Non-Marketing Materials
CMS distinguishes between “marketing” and “non-marketing” materials based on both intent and content:
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Non-Marketing Communications:
Provide general or educational information without steering beneficiaries toward a specific plan. Examples include updates, reminders, or basic Medicare explanations. -
Marketing Materials:
Aim to influence enrollment decisions or encourage retention in a specific plan. These materials often include plan details such as benefits, premiums, copays, or comparisons.
If you reference plan-specific benefits in printed ads, you must include the carrier’s name in at least 12-point font.
All marketing materials must be submitted to and approved by CMS through the Health Plan Management System (HPMS) before use, while non-marketing materials do not require prior approval.
Note: Any material mentioning benefits — even common ones like dental, vision, or hearing — is considered marketing and must be filed with CMS.
Ethical Marketing Practices
During sales presentations, agents must maintain complete honesty and transparency. Never use absolutes (“the best,” “the only,” “guaranteed”) or superlatives (“top-rated,” “highest savings”) when describing plans or benefits.
Your role is to present information accurately, not promote one carrier or plan over another.
If a prospect only asks about one plan, you are still required to inform them that other options are available. When enrolling a client, always explain how the new plan will affect their existing coverage to ensure informed decision-making.
Avoid Using the Term “Free”
CMS prohibits the use of the word “free” when describing any plan benefits, including $0 premiums. The term cannot be used in connection with reduced premiums, deductibles, or cost-sharing, even when referring to Part B premium buy-downs, low-income subsidies, or dual-eligible benefits.
While a plan may have a $0 premium, beneficiaries may still incur costs in other areas (e.g., higher copays or limited provider networks). Referring to a plan as “free” gives a misleading impression of the total cost.
Agents also cannot advertise generalized savings that may vary by individual circumstances.
Star Ratings and Plan Performance
When discussing Medicare Star Ratings, agents must clarify that:
“Every year, Medicare evaluates plans based on a five-star rating system.”
Agents may not:
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Reference star ratings from previous years when marketing future plans.
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Highlight positive star ratings without disclosing a Low Performing Icon (LPI) if CMS has assigned one.
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Publish or share star ratings before CMS officially releases them on the Medicare Plan Finder.
Events & Appointments
Throughout the year, the presentations and meetings you host will generally fall into one of three categories:
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Educational Events
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Sales Events
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Individual Appointments
Each type has specific CMS rules and compliance requirements you must follow.
1. Educational Events
Purpose:
Educational events are designed solely to inform Medicare beneficiaries about Medicare in general — not to market or sell specific plans. These events must be advertised as educational and conducted in a neutral, non-sales environment.
✅ What You Can Do
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Provide educational materials that do not contain plan-specific details.
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Distribute general health and wellness resources.
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Answer attendee questions about Medicare in general terms.
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Share your business card or contact info so beneficiaries can reach out to you later.
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Offer generic Business Reply Cards (BRCs) that allow beneficiaries to initiate contact.
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Host the event in a public venue (optional, but never in a private home or one-on-one setting).
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Include these required disclaimers in all advertisements and invitations:
“For accommodations of persons with special needs at meetings call [insert phone and TTY number].”
“This event is only for educational purposes and no plan-specific benefits or details will be shared.”
❌ What You Cannot Do
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Hold an educational session one-on-one or in a private residence.
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Hand out plan-specific materials, enrollment forms, or marketing brochures.
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Discuss or compare carrier plans or benefits.
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Use sign-in sheets or collect attendee contact information.
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Go beyond questions attendees voluntarily ask.
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Schedule marketing appointments or collect Scopes of Appointment (SOAs).
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Offer cash, monetary gifts, or rebates.
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Hold a sales event within 12 hours of an educational event in the same or adjacent location.
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Attempt to lead or steer attendees toward any particular plan.
2. Sales Events
Purpose:
Sales events are intended to present and compare specific Medicare Advantage or Part D plans — and are designed to help beneficiaries make informed enrollment decisions.
✅ What You Can Do
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Include the required TPMO disclaimer on all printed materials.
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Allow beneficiaries to approach you first if you’re hosting an informal event.
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Use optional sign-in sheets — never mandatory ones.
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Follow all carrier filing, approval, and cancellation procedures prior to the event.
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Announce all products and plan types you’ll discuss before beginning the presentation.
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Use only carrier-approved materials and approved talking points.
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Collect TCPA-compliant lead cards and Business Reply Cards (BRCs).
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Schedule follow-up meetings and collect SOAs for future appointments.
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Provide Summary of Benefits, Star Ratings, Pre-Enrollment Checklist, and Multi-Language Inserts with any enrollment form.
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Accept and process enrollment applications during the event.
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Follow up with attendees only if they have given documented Permission to Contact (PTC).
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Distribute nominal giveaways (pens, notepads, snacks, or refreshments) within CMS gift value limits.
❌ What You Cannot Do
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Conduct health screenings or request referrals.
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Offer cash, meals, or monetary gifts of any kind.
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Make absolute or comparative statements without proper documentation or carrier consent.
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Use pressure tactics to encourage enrollment.
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Cross-sell or promote non-health-related products.
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Require sign-ins, SOAs, or enrollment forms as a condition of attendance.
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Hold a sales event within 12 hours of an educational event in the same or nearby location.
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Use contact information from raffles or drawings for other marketing purposes.
Tip:
Agents have flexibility in their presentation style and delivery — only the carrier’s talking points must be filed with CMS, allowing for a more conversational, interactive approach when discussing plans.
3. Individual Appointments
Purpose:
One-on-one meetings — whether conducted in person, by phone, or via video call — are treated the same as sales events and must follow the same CMS regulations.
✅ Key Requirement
Before any individual discussion about plan options, agents must obtain a signed Scope of Appointment (SOA). This applies to both in-person and virtual appointments.
Websites
Any consumer-facing website that promotes specific Medicare Advantage or Part D plans — whether for a single carrier or multiple carriers — must be submitted to CMS for review and approval. This process is typically handled through the carrier(s), so be sure to check each carrier’s website policy for their specific submission and compliance requirements.
In recent years, CMS has tightened its oversight of agent and agency websites, so it’s essential to ensure your online presence is fully compliant and properly reviewed before going live.
Sunfire and Connecture DRX
Essential Care provides agents with free access to two of the industry’s leading quoting and enrollment platforms — Sunfire and Connecture DRX.
These platforms serve as client-facing enrollment sites, allowing you to:
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Compare plans side by side across multiple carriers
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Enroll clients seamlessly and compliantly
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Manage client data and track applications all in one place
Both tools are designed to simplify your workflow and help you stay compliant throughout the enrollment process. You can access your personalized site by registering through Essential Care.
Social Media
Your social media activity is subject to the same compliance standards as your website. Maintaining an online presence is a great way to connect with your community and build trust, but every post must remain accurate, compliant, and non-misleading.
Remember — likes, comments, or shares on social media do not count as Permission to Contact (PTC) for sales or marketing purposes. Always follow proper PTC guidelines before reaching out to discuss plan options.
Secret Shoppers
Compliance isn’t just a seasonal task — it’s a year-round responsibility for every Medicare agent. During Annual Enrollment Period (AEP), when new plans and updated CMS rules take effect, you’ll encounter all kinds of potential enrollees — and some of them may be CMS secret shoppers.
These individuals evaluate agent conduct, accuracy, and compliance with Medicare Advantage and Part D marketing regulations. Their goal is to ensure agents are following the rules — from what you say to how you say it during appointments, calls, or events.
As a certified Medicare agent, it’s your duty to remain compliant at all times. Staying compliant doesn’t have to be complicated — it simply requires awareness, preparation, and consistency in following CMS guidelines throughout the year.
Not affiliated with or endorsed by Medicare or any government agency.
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