All agents will also be required to include the following disclaimer:
“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 Medicare.gov or
1-800-MEDICARE to get information on all your options.”
The disclaimer must be included in the following places:
- Verbally expressed within the first minute of a sales phone call
- Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means
- Prominently displayed on the agent’s or broker’s website
- Included in all marketing materials, including print collateral (12-point font)
and television advertisements
Additionally, the following requirements must be included in all call recordings and appointment forms:
- Date of appointment
- Beneficiary and agent contact information
- Product types to be discussed
CMS has stated that there is no obligation to re-enroll current Medicare participants and their enrollment status will not be affected. Automatic enrollment will also not occur. That said, a new Scope of Appointment (SOA) is required if the beneficiary requests information about a plan not previously discussed.
NOTE: CMS has not laid out a compliance verification or auditing plan for the Final Rule 2023 changes.
Referral Fees / Marketing Gifts & Inducements
At Agent Boost Marketing, we have been receiving some questions regarding the topic of gifts/promotional items and want to share some further guidance on these regulations. The Social Security Act prohibits offering anything of value to a Medicare beneficiary in exchange for a referral or to influence their decision to enroll into a Plan.
Let’s define a few terms first of all
REFERRAL FEES – These fees are either cash or an item given to the source of the referral in exchange for referring a prospective insurance customer
These fees are lawful provided that they are given for every referral and not just those that result in an insurance sale. Acceptable fees can be paid in cash, with a gift card, merchandise etc. and these payments may be made to individuals for the referral to an agent, broker, or other entity.
- The payment may not exceed $100 for a referral into a MA or MAPD plan.
- The payment may not exceed $25 for a referral into a PDP plan
MARKETING GIFTS – Merchandise items given to prospective and current clients or policyholders, or the public that promote and advertise the licensee or agency.
Acceptable items include, but are not limited to
- Coffee mugs
- Golf balls
- Mouse pads
Marketing representatives may provide gifts, prizes, or promotional items to beneficiaries for marketing purposes as long as:
- The value of the item may not be worth more than $15.
- The item must be provided regardless of enrollment and without discrimination.
- When more than one gift is offered on one occasion, the combined value of all items must not exceed $15.
- Multiple gifts given to a beneficiary on different occasions may not exceed $75, per person, per year.
- Cash or monetary rebates may not be given as a nominal gift.
- Meals may not be given as a nominal gift. Only light snacks and refreshments can be provided at marketing events
It’s important to know that CMS no longer includes requirements about referral fees paid to non agents or brokers in the MCMGs (Medicare Communication and Marketing Guidelines). However any such fees would still be subject to general laws. Because of this we recommend that agents refrain from offering any incentives to induce referrals to non-licensed individuals, providers, members, or consumers. Furthermore, an agent who wishes to provide an incentive should contact the Department of Insurance in their state to verify that the incentive is compliant with state laws.
With all that said, here are a few recommendations of things you can and should do:
- Leave business cards for distribution to friends and family.
- Ask for and accept referrals (exp. Mailing addresses) from consumers or members
- Utilize conventional mail to send approved marketing information
- Send Thank You cards or notes in a compliant business relationship building activity
Now here are things you should NOT DO:
- Be sure to not make unsolicited contact from referrals from current enrolees
- Do not offer incentives to non-licensed individuals as an inducement for a referral
- Do not make any unsolicited phone calls
- Do not offer any item of value either up front to solicit or afterwards as a “thank you” in exchange for a referral from a provider, member, or other.
Thank you for your commitment to maintain compliance with all CMS regulations. And as always, thank you for your continued support, cooperation and business with Agent Boost Marketing
Please send all compliance related questions, concerns, marketing pieces to