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Insurance Division

Marketing rules for Medicare Advantage Plans and Medicare Prescription Drug Plans

Prohibited Agent Behavior

  • Agents cannot state that they are from Medicare or use "Medicare" in a misleading manner. For example, an agent cannot state that they are endorsed by Medicare, are calling on behalf of Medicare. or Medicare asked them to call or see the beneficiary.
  • Agents are prohibited from soliciting potential enrollees door-to-door.
  • Agents are prohibited from sending unsolicited emails.
  • Agents may not conduct outbound marketing calls, unless the beneficiary requested the call or the beneficiary is an existing client. (Agents are allowed to call their existing clients to discuss new plan options.)
  • Agents may not approach beneficiaries in common areas (i.e. parking lots, hallways, lobbies.)
  • Agents may not call or visit a beneficiary who attended a sales event, unless the beneficiary gave express permission.
  • Agents may not market non-health related products (such as annuities and life insurance) to prospective enrollees during MA or PDP sales activities or presentations. This is considered cross-selling and is prohibited.
  • Agents may not contact friends or family of clients under the premise that they had been "referred." Agents may leave cards behind for clients to provide to friend or family. The "referred" beneficiary has to contact the agent directly.
  • Agents cannot offer gifts to potential enrollees of more than $15. The value is based on the retail purchase price of the product.
  • Agents must clearly identify the types of products that will be discussed before marketing to a potential enrollee. They must initially meet with a beneficiary to discuss specific lines of business.
  • Prior to any marketing appointment, the beneficiary must agree to the "scope of the appointment" and that the agreement must be documented. For example, if a beneficiary attends a sales presentation and schedules an appointment, the agent must obtain written documentation that is signed by the beneficiary agreeing to the products that will be discussed during the appointment.
    • Additional products may not be discussed unless the beneficiary requests the information.
    • In addition, any additional lines of plan business that are not identified prior to the in-home appointment will require a separate appointment.
    • Appointments may not be re-scheduled until 48 hours after the initial appointment.
  • Agents may not make unsolicited contacts to beneficiaries under the guise of selling a non-MA or non-PDP product where the conversation turns to MA or PDP. For example, an agent may not begin by selling a Medicare Supplement plan and then turning the conversation to MA or PDP products.
  • Agents may not conduct sales activities in healthcare settings except in common areas. Appropriate common areas include hospital or nursing home cafeterias, community or recreational rooms, and conference rooms. Agents are prohibited from conducting sales presentation and distributing or accepting enrollment applications in areas where patients primarily intend to receive health care services. Improper areas include waiting rooms, exam rooms, hospital patient rooms, dialysis centers and pharmacy counter areas. Agents are only permitted to schedule appointments with beneficiaries residing in long term care facilities upon request. Agents may not provide meals to potential enrollees at sales presentations. Agents may not engage in marketing or sales activities at an educational event.

Appropriate Agent Behavior

  • Agents or brokers who enrolled a beneficiary in a plan may call that beneficiary while they are a member of that organization.
  • Agents may call beneficiaries who have expressly given them permission for a plan or a sales agent to contact them, for example by filling out a business reply card or asking a Customer Service Representative (CSR) to have an agent call them. The permission applies only to the entity from whom the beneficiary requested contact, for the duration of that transaction, or as indicated by the beneficiary.
  • Agents may initiate a phone call to confirm the appointment that has already been agreed to by a beneficiary, but may not change the scope of the appointment without appropriate documentation.
  • Sales presentations to groups of beneficiaries do not require documentation of the beneficiary agreement because they are not personal/individual sales events.
  • While agents are no longer permitted to provide meals, they may provide refreshments and light snacks to prospective enrollees at sales presentations.