The Centers for Medicare & Medicaid Services (CMS) have established Scope of Appointment (SOA) rules for 2025. The SOA is a mandatory form that both agents and clients (or potential clients) must complete prior to any discussions about Medicare plans, including Medicare Advantage and Prescription Drug Plans (PDPs). Collecting an SOA before meetings is a best practice, as it helps safeguard both agents and clients.
Verbal Scope of Appointment
During the pandemic, in-person meetings to discuss coverage options were no longer feasible, leading many agents to conduct appointments over the phone. As a result, recorded verbal Scope of Appointment (SOA) agreements became a common practice during this period.
SOA Information:
- If the client initiates the call (inbound), the 48-hour rule does not apply.
- A signed Scope of Appointment (SOA) is valid for 12 months from the signature date. Be sure to complete the appointment within that time frame or obtain a new SOA.
- If the call gets disconnected and the same agent reconnects with the client, the SOA remains valid.
- However, if new benefits are introduced during the conversation, a new SOA will be required.
SOA Validity:
A Scope of Appointment (SOA) is valid for 12 months from the date it’s signed. During your appointment, it’s essential to stick to the products listed in the agreed-upon scope. If you want to discuss any additional products, the beneficiary must sign a new SOA.
If a new SOA is required, the 48-hour waiting period resets, which could delay your meeting. This rule applies to all products regulated by CMS.
CMS Guidelines:
To comply with CMS regulations, agents must have clients complete a Scope of Appointment (SOA) form. As of September 30, 2023, the updated CMS final rule introduced new requirements for how agents collect SOAs.
These SOA rules apply to agents and brokers who discuss Medicare coverage options and plans. The 48-hour rule was implemented to protect beneficiaries from high-pressure sales tactics by giving them time to consult others and research their options. This waiting period also allows agents time to prepare for the discussion.
Once the SOA is completed, agents can contact the beneficiary for up to 12 months, providing ongoing permission to engage until the meeting takes place. Beneficiaries have the option to opt out each year.
Additionally, if a beneficiary does not select a specific coverage option on the SOA, Medicare requires that agents refrain from discussing that option unless a new SOA is signed with the coverage clearly indicated.
Exceptions to the 48-Hour Rule:
- If the beneficiary is within the last four days of a valid election period, agents are allowed to collect a same-day SOA.
- When a beneficiary walks into your office and initiates a conversation about coverage options, or if they call the agent requesting advice, a same-day SOA can also be collected.
How Long to Keep a SOA:
Agents are required to retain the SOA form for 10 years. During this period, clients have the right to request a copy at any time without any difficulty. The SOA serves as protection for both the consumer and the agent, providing a record that can be useful in resolving any issues or disputes.
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