CMS Guidelines for Communicating With Clients

As a Medicare insurance sales agent, it’s important to be aware of government files and regulations governing how you can contact potential clients. Included in the scope of compliance requirements are cold calls, flyers, brochures, your social media posts, and even your website! Let’s dive into the regulations together that will align your communication with the rules.


Part 1: General Regulations and Disclaimers

Contacting potential clients before they opt in is possible using generic marketing materials and not mentioning any plan specifics. These educational communications can explain the basics of Medicare, the differences between Original Medicare and Medicare Advantage, and alerting potential enrollees to upcoming enrollment events such as the Annual Enrollment Period or Initial Enrollment for those who are newly eligible for Medicare.

Though it may seem like a lot of unnecessary regulations, Medicare marketing compliance rules are designed to ensure that marketing activities related to Medicare Advantage and Medicare Part D comply with applicable laws, regulations, and guidelines and are conducted in an ethical and responsible manner. The rules are enforced by the Centers for Medicare & Medicaid Services (CMS), which is responsible for overseeing the Medicare program.

Some of the key Medicare marketing compliance rules include:

1. Prohibition on misrepresentation: Marketing materials cannot contain false or misleading information or misrepresent a Medicare plan’s benefits, features, or coverage.
2. Compliance with CMS guidelines: All marketing materials must comply with CMS guidelines and regulations, including guidelines for using the Medicare logo and other official Medicare program materials.
3. Prohibition on unsolicited contact: Medicare marketing representatives cannot make unsolicited contact with Medicare beneficiaries, including through cold-calling, door-to-door visits, or direct mail.
4. Permission-based contact: Medicare beneficiaries must give permission for marketing representatives to contact them and can revoke that permission at any time.
5. No discriminatory practices: Medicare marketing representatives cannot engage in discriminatory practices, such as targeting beneficiaries based on race, ethnicity, gender, or other protected characteristics.
6. Compliance with annual enrollment periods: Marketing activities related to Medicare plans must be conducted only during designated annual enrollment periods.
7. Required disclosures: All marketing materials must include required disclosures, such as the plan’s coverage and benefits, cost-sharing requirements, and limitations on coverage.

Non-compliance with Medicare marketing compliance rules can result in penalties, including fines, suspension or termination of marketing privileges, or other corrective actions. Therefore, all Medicare marketing representatives and organizations must be aware of and comply with these rules to avoid potential penalties and ensure that they conduct business responsibly and ethically.


Part 2: Technical Compliance Requirements

More specific information to note is the content of the marketing material itself.

Font Size: The font should be no smaller than the equivalent of Times New Roman at 12 points. This ensures readability especially for enrollees who may have trouble with eyesight.
Disclaimers: Marketing materials (as opposed to Communication materials) require certain disclaimers concerning the content included. See the end of this document for acceptable disclaimer language.
Agent Titles: Must not mislead individuals into thinking they work for the government. Approved titles from CMS are Licensed Sales Agent, Licensed Sales Representative, Sales Agent, Sales Representative, and you can add “Specializing in Medicare” after the title.
Referring to Potential Clients: Since Medicare is available to not just those over 65, CMS prohibits marketing materials that refer to potential clients as “seniors” or “over 65.” Instead, say “beneficiaries” or “Medicare beneficiaries.” For Turning 65 materials, also use the phrase “Will you be turning 65 or new to Medicare?”
Carrier Logos: Any materials using carrier logos must be approved by those carriers before use.
Discriminatory Language: CMS prohibits use of verbiage or questions that discriminate based on race, ethnicity, gender, sex, religion, nationality, age, mental or physical disability, and health status, and you can’t ask for that information, either.
Income: Targeting individuals from higher income areas is prohibited.
Referencing Medicaid: Must state that the material is advertising a Dual Eligible Special Needs Plan.
Promotions: If gifts or drawings are being advertised, you must state that it is a “Free gift without obligation to enroll.”
Government Look-Alike: Avoid the overuse of the American flag, the Medicare or Medicaid ID card, or patriotic colors (red, white, and blue).
Entitled vs. Eligible for: Materials may only say that potential enrollees are “eligible for” not “entitled to” plans or benefits.
• In addition, you cannot use absolute statements, scare tactics, false implications, or deadline pressure in marketing materials.


Part 3: Disclaimer Language:

Regarding uncommon benefits such as dental, vision, or hearing:
“Not all plans offer all these benefits. Availability of benefits and plans varies by carrier and
location. Deductibles, copays and coinsurance may apply.”

Regarding benefits uncommon to Medicare Advantage such as flex cards or grocery benefits, also add:
“These benefits may be included with some plans in certain areas to qualifying beneficiaries.”

Regarding Part B Giveback:
Must be clear that it’s referencing Part B giveback and not “money back in your pocket!” Also it must include, “Part B Premium give-back is not available with all plans. Availability of benefits and plans vary by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays, and coinsurance may apply.”

Regarding Cost Savings:
“There may be plans that may help you save money.”

Regarding a la Carte Benefits:
Must not imply that benefits can be added. Instead, materials must make it clear that the client must enroll in a new plan that offers the mentioned benefits.

Including Agency Logos:
When a logo is included, it must be accompanied by this text, “A non-government entity powered by <Agency Name>, a health insurance agency.”

Regarding OEP Marketing:
CMS prohibits marketing targeting the Open Enrollment Period (January 1-March 31 of each year.” Materials used outside of AEP should clearly state that a valid SEP qualifier is required to enroll during this time period.


Remember that this is only an overview of the main points of Medicare marketing compliance. Always be sure to check your marketing materials against the official guidelines found here. If you want to avoid the hassle of ensuring your documents meet compliance, Fidelis Consultants has a library of compliance-checked materials available for its agents. Reach out to a local Sales Director today for more information on becoming an agent with Fidelis.