The Centers for Medicare and Medicaid Services (CMS) publishes guidelines yearly that provide insurance brokers and agents with rules about disseminating marketing materials and engaging in informational communications with Medicare beneficiaries.
Referred to as the Medicare Communications and Marketing Guidelines, these policies protect Medicare beneficiaries from unscrupulous business tactics, including fraud, undue pressure, and other forms of misinformation.
Understanding these rules is vital for agents to remain in compliance, and it’s also helpful for Medicare beneficiaries to be aware of these policies to avoid working with an agent that uses unethical tactics.
What Is Permission to Contact?
Referred to as PTC for short, the Permission to Contact rule sets forth the circumstances for the following:
- How an agent can contact a Medicare beneficiary
- What products an agent can contact someone about
- Allowable places to approach a Medicare beneficiary
- When beneficiaries can be contacted, including the time of day
The Permission to Contact rule resulted from beneficiaries being pressured to sign up for coverage or specific products that gave an agent a financial incentive or commission. Often, a beneficiary would be enrolled in plans unknowingly.
As a result of these tactics, beneficiaries were often steered toward enrollment in a plan they didn’t like that prevented them from seeing their preferred doctors or getting the medical care they wanted.
As a rule, a beneficiary must initiate contact, and the agent can only respond by contacting a beneficiary with the information about the Medicare plans they specifically requested. A Medicare beneficiary must also provide authorization for private information to be released to a third party.
When Does Permission to Contact Expire for Medicare Advantage and Prescription Drug Plans?
Just because someone has obtained permission to contact a consumer about Medicare does not mean the permission lasts indefinitely. Depending on the specific plan, PTC expires.
- For both Medicare Advantage plans (also referred to as an MA plan for short) and prescription drug plans, the permission to contact window lasts for 9 months.
- For Medicare Supplement plans, it’s 90 days.
After this time, permission to contact expires, even if you’re already in correspondence. To remain in compliance, agents must renew their PTC.
How to Comply with Medicare Permission to Contact Guidelines
An agent should be familiar with and follow the guidelines to ensure compliance. The overarching rule about Permission to Contact is that you must get permission to initiate contact and make marketing calls.
The following list provides a general outline of how an agent can be compliant. Agents should study any updated guidelines to ensure they’re within the scope of what’s allowed.
- Before initiating a phone call, ensure clients have filled out a Business Reply Card
- Only call a beneficiary when they have requested a phone call
- A broker may return phone calls but cannot make unsolicited calls
- All marketing calls should be recorded (both inbound and outbound)
- Include a Scope of Appointment form that outlines what you’ll discuss with the client during an appointment
- Disclose the use of subcontracted providers of lead-generating activities
- Direct mail can be sent unsolicited without PTC
- Report any disciplinary action taken with agents on staff
The act of making a seemingly innocuous phone call is where agents have the most potential to get in trouble. Therefore, it’s vital that the beneficiary has requested to be contacted before making a call. The request can come in the form of a Business Reply Card or a client initiating a call.
While an agent may not initiate a phone call, they can return a phone call from a beneficiary asking for a return call from a Medicare Part D sponsor. A beneficiary can also request a phone call from an agent through a customer service representative.
In addition to the above list, agents must also include disclaimers about the limitations of plan availability in a service area (if applicable) and information about how to contact Medicare directly to inquire about plan choices. The disclaimer must be in all communication platforms, including phone calls, emails, and mailed information.
Further, if you host educational events, you must also comply with specific stipulations. While agents are permitted to distribute educational materials and give out business cards, agents cannot promote a specific Medicare plan, hold a marketing event in one’s home or in a one-on-one setting, provide meals, or require that attendees disclose contact information on a sign-up sheet. While an agent can include a sign-up sheet, filling in contact details must be optional.
What to Avoid When Contacting Potential Clients about Medicare and Prescription Drug Plans
A short list of prohibited activities is as follows:
- Making unsolicited calls
- Sending text messages
- Engaging in social media direct messaging
- Visiting beneficiaries by going door-to-door
- Leaving marketing materials at front doors or on car windows
- Approaching people in common areas, including sidewalks, parking lots, and lobbies
2019 Changes to Medicare Permission to Contact Requirements
In general, unsolicited direct contact was barred in the originally published guidelines. However, as of 2019, brokers can now contact Medicare beneficiaries and potential and current clients about enrollment in a plan via email. To remain in compliance, each email correspondence must include an option to opt out of further communication, and the direct mail message cannot promote a particular plan.
Advantages of Complying with Permission to Contact Policies
Staying out of trouble with CMS secret shoppers who regularly monitor agents is one of the most obvious benefits of complying with Permission to Contact policies. Another key advantage is that following the guidelines allows you to build and maintain trust with your clients.
Exceptions to Medicare Permission to Contact Guidelines
Despite the stringent policies regarding client communication, there are exceptions. Ongoing contact may be allowed in the following circumstances:
- An existing contract with another product, such as life insurance
- An active business relationship
- Agent of record is specified for the beneficiary’s plan, and you’re the agent
Once an agent has received Permission to Contact, they can schedule an appointment to discuss the plan the beneficiary has requested information about. If a beneficiary is interested in Medicare Advantage plans, the agent may also cover the top reasons to choose a Medicare Advantage plan.