The Centers for Medicare & Medicaid Services (CMS) enforce strict regulations governing what agents can and cannot say during Medicare sales appointments. However, navigating the detailed Medicare Advantage & Part D Communication Requirements can be overwhelming and time-consuming — so here’s a simplified breakdown to make it easier.
We also know that these rules can sometimes cause confusion for both agents and beneficiaries. That’s why it’s important to keep your conversations clear, compliant, and confidence-building for your clients when discussing Medicare Advantage and Part D plans.
So, let’s dive in! Here are some examples of phrases and practices that are not allowed during Medicare sales appointments…
“I’m a Medicare Agent.”
This is one of the most common — and most misunderstood — compliance pitfalls in Medicare marketing. Agents cannot represent themselves in any way that could make beneficiaries believe they work for, are endorsed by, or are recommended by Medicare or the U.S. government.
You also may not use the word “Medicare” in a misleading manner within your business name, website URL, or branding. For example, if your business is called “Medicare Enrollment Center” and prospects have ever assumed you’re part of a government agency, that’s a red flag — and a sign that it’s time to rebrand.
Always ensure it’s clear that you operate as an independent licensed insurance agent — on your website, business cards, and all other marketing materials. Transparency protects both your credibility and your compliance standing.
“These Plans Are Free!”
Avoid using the word “free” when describing any Medicare plan — it’s considered misleading under CMS rules.
While some Medicare Advantage or Prescription Drug Plans may feature $0 premiums or copays, that does not mean the plan has no costs. Beneficiaries may still be responsible for deductibles, coinsurance, copays, or may be limited to specific provider networks and service areas tied to those $0 benefits.
CMS marketing guidelines clearly prohibit plans, Part D sponsors, and agents from using the term “free” to describe:
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A $0 premium or premium reduction
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Any deductible or cost-sharing reduction
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Low-income subsidies or dual-eligible cost-sharing benefits
Instead of saying a plan is “free,” use accurate phrasing such as “$0 monthly premium” or “no additional premium,” ensuring your communication stays compliant and transparent.
“This Plan Is the Best One on the Market.”
It might feel natural to use words like “best” when selling, but in Medicare marketing, superlatives are off-limits unless they can be proven with current, factual data that meets CMS standards.
According to CMS guidelines, plans, Part D sponsors, and agents may not:
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Share inaccurate or misleading information
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Make unsubstantiated claims, unless they appear in an approved logo or tagline
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Mislead or confuse beneficiaries, or misrepresent a Medicare Advantage organization
This rule applies to all forms of communication — written, spoken, or digital.
Instead of using subjective language like “best,” focus on objective comparisons and verifiable benefits to help clients make informed decisions while staying fully compliant.
“This Plan Will Cover All of Your Needs!”
No Medicare plan can meet every possible need a beneficiary might have — and suggesting otherwise can be misleading.
As an agent, you understand that each plan has its own coverage limits, networks, and costs. Avoid promising that one plan is a “complete solution” for a client’s health or financial needs.
Instead, guide beneficiaries toward a plan that best fits their individual situation, making sure they understand what’s included — and what isn’t — so their expectations remain realistic and compliant.
“I Have Every Medicare Advantage Plan You Could Want!”
You can’t claim to offer all Medicare Advantage or Prescription Drug Plans in your area unless you truly do — and with more than 3,700 Medicare Advantage plans available nationwide for 2025, that’s nearly impossible.
CMS reinforced this in the 2024 Final Rule, which explicitly prohibits agents from marketing benefits or plans that aren’t available in a beneficiary’s service area. This rule is especially important when promoting 5-star plans, Special Needs Plans (SNPs), or Part B giveback benefits.
To stay compliant, you must be transparent about the number of plans and carriers you represent. CMS requires agents and TPMOs to include a disclaimer on all marketing materials, websites, emails, and phone calls stating how many plans they offer within a given area.
Always represent yourself honestly — it builds trust with clients and keeps your marketing fully compliant with CMS regulations.
“Your Current Coverage May or May Not Change.”
This kind of vague statement doesn’t meet CMS standards. When helping a beneficiary enroll in a new plan, you’re required to clearly explain how their existing coverage will be affected — whether it’s being replaced, modified, or ending altogether.
Always take the time to review these details with potential enrollees so they fully understand the impact of their enrollment decision before moving forward.
“You Have to Join This Plan, or You’ll Lose Coverage Next Year.”
Using pressure tactics like this is non-compliant and strictly prohibited. A client’s Medicare eligibility does not depend on enrolling in any specific plan.
Instead of creating urgency or fear, focus on educating clients and helping them find a plan that best matches their health needs and financial situation.
By practicing ethical, compliant sales methods, you not only protect your clients — you also build trust and long-term success as a Medicare agent.
“These Benefits Are Medicare-Approved.”
Avoid using this or any similar phrase — whether in conversation or on marketing materials. Statements that suggest Medicare or the federal government has approved or endorsed a specific plan or its benefits are strictly prohibited.
Just as you cannot imply that you represent Medicare, you also cannot say things like:
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“These benefits were approved by the government,” or
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“The president authorized these plans.”
Always make it clear that you are an independent, licensed insurance agent, and that the plans you discuss are offered by private insurance companies contracted with Medicare — not approved or endorsed by the government.
“This PPO Plan Supplements Your Medicare Benefits.”
Avoid using this phrase — it’s misleading and can easily confuse beneficiaries.
Medicare Advantage (MA) plans are not Medicare Supplement (Medigap) plans. MA plans replace Original Medicare coverage by providing benefits through a private insurer, whereas Medigap plans are designed to fill the coverage gaps in Original Medicare.
Be clear when explaining the difference so clients fully understand the type of coverage they’re enrolling in.
“If Your Doctor Accepts Medicare, They’ll Accept This Plan.”
This statement can be misleading and should be avoided. While a doctor may accept Medicare, that doesn’t mean they participate in every Medicare Advantage plan or with every carrier’s network.
Instead, encourage clients to bring a list of their preferred doctors and pharmacies, and use platforms like Sunfire or Connecture to verify network participation before enrolling them in a plan.
This ensures your clients have accurate information and helps them choose a plan that truly fits their healthcare needs.
“You Need This Plan.”
Telling a client they need a specific plan is both non-compliant and poor sales practice. It comes across as pushy and presumptive, which can make beneficiaries feel pressured or skeptical — the exact opposite of what builds trust.
Remember, your role as an agent is to educate, not dictate. Instead of using high-pressure language, focus on explaining options clearly, helping clients understand which plans best fit their unique needs and budget.
Empowering clients to make informed decisions is far more effective — and compliant — than trying to convince them they “need” something.
“If You Enroll Today, I’ll Give You a Free Gift!”
Offering incentives or gifts in exchange for an enrollment is strictly prohibited under Medicare marketing rules — and it’s considered illegal.
Using bribes or rewards to encourage sign-ups isn’t just a compliance violation; it also undermines trust and professionalism.
Instead, focus on educating clients and helping them choose a plan that genuinely meets their needs — not one they feel persuaded to join for a giveaway.
“Do You Have a Dental, Vision, Hearing, or Hospital Indemnity Plan?”
This question can easily cross compliance lines if you’re not careful. You may only discuss ancillary products like dental, vision, hearing, or hospital indemnity plans if the client selected those options on their Scope of Appointment (SOA) prior to the meeting.
If those boxes weren’t checked, you cannot bring up or promote these additional plan types during a Medicare sales appointment.
And remember — cross-selling other non-Medicare products, such as life insurance, annuities, or similar offerings, is strictly prohibited during any Medicare sales discussion. Always stay within the approved scope to remain fully compliant.
“I’m Accepting Referrals — Do You Have Any Names and Numbers?”
While you’re allowed to ask for referrals as a Medicare agent, you cannot request or collect contact information (like phone numbers or emails) for those referrals.
Instead, keep it compliant by asking clients to share your contact information with friends or family members who might need assistance. Hand them a few of your business cards and encourage them to pass them along.
This approach not only follows CMS guidelines but also allows potential clients to reach out to you voluntarily — keeping your referral process both ethical and effective.
Making Sense of Medicare Marketing Rules
The Medicare Advantage & Part D Communication Requirements can feel like a lot to take in — and that’s completely understandable. With so many regulations to keep track of, it’s easy to feel overwhelmed. But don’t worry — we’re here to make things simpler.
By understanding the basics and following these Medicare marketing guidelines, you can approach every appointment with confidence, knowing you’re compliant and ready to serve your clients the right way.
Note: This post offers a helpful overview of what not to say during Medicare sales conversations, but it’s not a complete list. For full details on what’s permitted and prohibited, be sure to review the official Medicare Communications and Marketing Guidelines and the Medicare Advantage & Part D Communication Requirements from CMS.
Not affiliated with or endorsed by Medicare or any government agency.
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