Medicare Advantage sales: rules, rules, and more rules

Insurance agents have turned up at the homes of seniors stating they are from Medicare and that they need to talk about the senior’s Medicare coverage.   Health fairs have invited seniors in for flu shots and free food, with hopes of getting leads for insurance agents who can follow up with sales calls.

These are just a few examples of problems that have plagued the Medicare market over the years.  Now rules are in place and secret shoppers are lurking to make sure insurance agents comply with the many new rules concerning sales and marketing of Medicare Advantage plans.

Here are a few of the rules related to Medicare Advantage sales and Marketing:

  • While knocking on seniors’ homes without an invitation has always been against the rules, now agents are forbidden from initiating contact with Medicare beneficiaries in any way, except by mail.  Agents can call their own clients, but they cannot call someone they have never worked with.
  • Agents can ask clients for referrals of friends and relatives, but they cannot receive phone numbers to call these prospects.  If a senior wants to help a friend, she needs to give her friend the agent’s phone number so the friend can initiate contact with the agent.
  • When an appointment is made between an agent and a senior to talk about Medicare Advantage, both parties must clearly agree on what will be discussed.  A form called a “scope of appointment” must be signed by the senior before Medicare Advantage plans are discussed. This form should be mailed to the senior and the senior must mail the form back to the agent after signing it and agreeing to the scope of the appointment.
  • Agents have the option of recording the phone call during which the terms of the appointment are reviewed and agreed upon.
  • If a neighbor shows up for the arranged appointment, she must sign a scope of appointment before the discussion of Medicare Advantage can begin.
  • Educational events, such as health fairs, can include insurance agents, but agents cannot present any plan-specific Medicare Advantage information to attendees. Agents cannot give their card to attendees – unless an attendee asks the agent for his/her card.
  • Educational events are defined as any event that provides free food.
  • Sales events must be registered in advance with Medicare so secret shoppers can attend to be sure agents are compliant in their sales presentations about Medicare Advantage.

I’m not going to editorialize about these rules for fear of breaking any rules.

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8 Responses to "Medicare Advantage sales: rules, rules, and more rules"

  1. ldonyo says:

    If Medicare Advantage plans were worth the paper they are printed on, insurance agents would not need underhanded tricks to get seniors to sign up for them, would they? These agents are clearly the checks-and-stripes-wearing used car salesmen of the insurance industry.

  2. insurance agent says:

    I have a client who makes fifty dollars too much to qualify for AHCCCS. She never had a Medicare Supplement and she couldn’t get one now if she wanted one — because of her health problems and the fact that she can’t afford $300 per month for one.  She is in a Medicare Advantage plan that has no  premium, no co-payment for doctor visits, and no copayment if she ends up in the hospital. This plan is designed for people who have less than $1200/month in income and it includes Part D.  How is this a bad plan?  This lady is worried that she is getting too many tests to try to figure out what’s wrong with her. She asked me if she will hit her maximum and I told her there is no maximum amount the plan will spend on her.

    Medicare Advantage plans have some issues, but the Health Net Amber plan is a lifesaver for this lady.  I’m an insurance agent and I feel like a social worker when I’m helping seniors like this lady get help for her Medicare costs.  Then she qualified for a plan like Health Net Amber. 

    Why didn’t someone from Medicare or the state help this lady? It seems like I’m the only one who has helped this lady, and many other seniors, to get help with their Medicare and drug costs.  I am not a bad person, so don’t label me.

  3. kelly smith says:

    you should chabge your name to( Idontknow) cause you clearly know nothing about this subject.

  4. kelly smith says:

    You are so right it is ashamed that the social workers don’t tell the clients about any of the programs that are out there,I spend more time enrolling folks in LIS and helping them get reimbursed on part b premiums when they have social workers who have made no mention of  the help they could be getting. people like are so fast to accuse us of wrong doing when we do so much to help these people.

  5. Andrew says:

    Yeah there are many rules, and while CMS is trying to protect the consumer, I feel they have gone a bit too far.  I was secret shopped by one and was not happy with the result.  One example is having to explain all the enrollment periods.  It is already confusing to people – why bring up information that doesn’t apply to them?  Anyway, some have decent plans I I have helped a number of people with them.  I like to carry them for those who benefit this kind of plan.  However, with CMS lurking to play “gotcha” – I am considering dropping them altogether and primarily illustrating something like Plan N Med Supp.  This is one of the problems with social medicine – and socialism in general… they always love control.  Too much.

  6. NMD Adidas says:

    Thanks for this howling post, I am glad I discovered this web site on yahoo.

  7. Dan says:

    I know this post is older, but I still am thankful I found it. As a newer agent, honestly, CMS just makes me want to throw my hands up in the air and say “f*%k it!” Let them pedal this themselves. I think Medicare Advantage is a great plan for most people, but they make it almost impossible to drum up business. I mean, for most agents, it would take about 10 years to get any sort of sustenance going.

    Between the completely unnecessary (and RIDICULOUSLY HARD) AHIP exam, every single year, the hundred million marketing rules, and the million things you have to remember about each specific plan (that is ALWAYS changing), you have to be damn near Tesla to master this, be able to drum up business, and be successful.

    I’m all for protecting seniors, but it’s just gone WAY too far, and is an extreme overreach. Honestly, when I present Medicare Advantage, the seniors are basically leery to sign much of anything, because I keep having to explain that “it’s just a rule for your protection, and CMS mandates that you sign this.” I mean, hell, if I was a senior, that would make me leery, too.

    And the plans are actually for their benefit, and are really good! lol. CMS seriously needs to take a closer look at this, because it’s a joke.

  8. Dan says:

    I forgot to also add….and then, on top of EVERYTHING I just posted, if you don’t pass the AHIP exam, for any given year, they will take away ALL of your previously earned business. Work for 10-15 year, get successful, and happen to get an 89% on the test that demands a ridiculous 90%…..no more business for you! Land of the free? lol. What a joke.

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