Agent Compliance

AEP 2023

Big Changes For This Year's AEP!

CMS has finalized new Medicare marketing rules for MA, MAPD and PDP marketing for the 2023 AEP. These new rules will have a significant impact on your sales and marketing activities. In conjunction with our partners at Integrity, we are sorting through these new rules and developing tools and technology that will help you meet these new challenges.

The most significant rule change is the new requirement to record all calls with your clients and prospective clients. Absent further clarification from CMS, this requirement appears to include inbound and outbound calls with consumers associated with the chain of enrollment including lead generation, marketing, and the enrollment process.

We are still reviewing the new rules and working through compliance and legal specialists at Integrity to address questions and concerns about the new rules and how best to implement them. In the meantime, Integrity has created a FAQ document which addresses many of the questions that you may have. As we receive updated information, we will communicate it to you.


Compliance is Key

While you’re working with current clients and developing new sales possibilities, it’s critical to keep in mind that staying compliant is essential for working in the insurance industry. Savers Marketing is always willing to help agents excel in the field—and an important part of your success is ensuring you are compliant. 


How to Avoid Unqualified Sales

Some of the most basic compliance concerns to remember:

  • Verify that your State Appointments are kept up-to-date with each Carrier.
  • Ensure that any product certifications required by the carrier, particularly for Medicare products are completed prior to soliciting business. 
  • Make sure your state license(s) are current and your Continuing Education (CE) requirements are up to date.
  • Do you have downline agents? It is your responsibility to ensure that they are compliant as well so training them on insurance compliance issues is an important part of running your agency.

Educational and Sales Events for AEP

During the Medicare Advantage Annual Enrollment Period (AEP), many agents use educational or sales events to get in front of clients and prospects to create new sales opportunities. Ensure that you are meeting the compliance standards set forth by CMS and the carriers that you represent.


Important Details to Remember About Sales Events

  • Sales events must be reported to the carrier you represent.
  • A “Nominal Gift” is defined as any promotional product that costs no more than $15.
  • Attendees are not required to supply their contact information.
  • You CANNOT offer meals.
  • Agents CAN conduct marketing activities such as discussing plan information, distributing marketing materials, and collecting/distributing enrollment paperwork.
  • You must be present for the event. No-shows are a CMS violation, so you’ll need to attend your scheduled event or follow the cancellation procedure within the prescribed time period.

Educational Events 

An Educational Event is an event that informs beneficiaries about insurance programs. It does not include marketing activities (i.e., the event sponsor does not steer, or attempt to steer, potential enrollees toward a specific plan or a limited number of plans). They must be held in a public place and advertised as educational.



What Should Clients Expect from Educational Events?

  • Receive information about Medicare, Medicare Advantage, Prescription Drug, or other insurance Programs.
  • Promotional Items that are of nominal value and free of benefits information. These items may display the Plan Name, Logo, Toll-free Number, and Website.
  • Contact information and business cards for beneficiaries to reach out.
  • Opportunity to schedule future appointments. 
  • Opportunity to submit Scope of Appointment Forms.
  • Receive answers to their insurance-related questions
Agents should AVOID  the following at educational events:
  • Providing or discussing specific plan materials.
  • Distributing sign-up sheets or enrollment forms.
  • Collecting or distributing specific plan applications.
Insurance Agent Compliance Marketing

Advertising Compliance 

We understand how important it is for you to promote your company and advertise yourself as an insurance professional. However, it is important to adhere to the laws and guidelines set forth by the Federal and State governments as well as the requirements of the carriers that you represent.

Effective October 1st, 2022: The following TPMO disclaimer must be used in designated marketing activities:

“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact or 1-800-MEDICARE to get information on all of your options.”

  • The TPMO Disclaimer must be used in all of the following situations:
    • Verbally within the first minute of a sales call.
    • Electronically when communicating with a beneficiary through email, online chat, or other electronic means of communication.
    • Prominently on your TPMO website.
    • All marketing materials, including print materials and TV ads, that you develop, use, or distribute.
  • You are NOT REQUIRED to use the TPMO Disclaimer:
    • When meeting with a beneficiary in person.
    • If you only sell plans on behalf of one carrier.
    • If you sell plans on behalf of more than one carrier and you sell all commercially available MA or PDP plans in a given service area.

When developing marketing and advertising materials, keep the following points in mind:

  • Material names or logos, plan-specific names, unique plan benefits, star ratings, and similar identifiers are prohibited. Specific Plan Benefits should not be used to identify a plan or carrier.
  • It must be evident to recipients that you are not connected with or endorsed by the Federal Medicare program or the government. Here’s a sample disclaimer (which is required in some states, so we always suggest using it):
  • If you’re presenting your product or service to the public, make sure everything you send includes a phone number for them to contact a licensed insurance agent. Make sure the language surrounding the phone number informs consumers that they’ll be calling a licensed insurance agent:

If your marketing piece includes a Business Reply Card (BRC) to get permission to contact:

  • A statement informing the consumer that an agent may contact them must be included in your BRCs., for example:
    “By providing the information above, I grant a licensed insurance agent permission to contact me regarding my Medicare options, including Medicare Supplement, Medicare Advantage, and Prescription Drug Plans.”
  • It’s unnecessary to know the consumer’s Date of Birth, according to Medicare rules. Instead of asking for a consumer’s Date of Birth, BRCs should target their inquiries on his or her Age or Date of Medicare eligibility, as well as Month and Year of birth.
  • BRCs aren’t permitted to retain data for longer than the CMS retention requirements (10 years).
  • When describing plan benefits, avoid using the word “Entitled.” Instead, use the word “Eligible.” “Entitled” may be used in referencing Part A for Federal Medicare Products.
  • When using the phrase “Senior,” exercise caution. You can’t restrict your audience to people over 65; some Medicare recipients are under the age of 65.
  • Avoid using absolute superlatives and hyperbolic phrases, such as “the best,” “top-rated,” “the most,” “all,” etc.
    • For example: Instead of stating, “I represent all the best plans in the area,” you should say, “I’m an independently licensed insurance agent, and I represent multiple competitive plans in the area.”

Insurance Agent Website Compliance

Unless you obtain permission from each relevant carrier, avoid using carrier logos and branding. One should also avoid listing particular plan names, benefits, and expenses. To make things more precise, you can pick from a variety of agent titles. Don’t use words or phrases that would mislead customers into thinking you’re associated with the Government or the Medicare Program. If selling Medicare, do not use the term “Medicare” in your title. If you are an insurance salesperson who is licensed to sell, express that with your title (ex. Licensed Sales Agent, Sales Representative, Independent Insurance Agent, Licensed Insurance Representative).

Compliance Resources

The ultimate goal of Savers Marketing is to help insurance agents reach their full potential. Are you interested in furthering your education as an insurance agent to stay compliant? Check out our training opportunities for webinars on the latest compliance issues and standards. You can also refer to the resources below for more detailed information on compliance.