How to Stay Compliant During All Medicare Sales

During the 2023 Annual Enrollment Period (AEP), the Centers for Medicare & Medicaid Services (CMS) reviewed thousands of complaints and found that many beneficiaries were receiving misleading or inaccurate information. Consequently, CMS started more heavily monitoring Medicare marketing practices through increased “secret shopping.”

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CMS employs secret shoppers who then call numbers associated with TV ads, newspaper ads, mailings, and internet searches to get a glimpse of the beneficiary experience. Agents should expect this closer scrutiny to continue for the 2024 AEP. If you make an effort to prioritize compliance every time you make a sale, you’ll make both your clients and secret shoppers happy.

Record Marketing, Sales, & Enrollment Calls with CallVault

If you sold Medicare Advantage products last enrollment season, you already know that the CMS’ 2023 Final Rule started requiring all marketing, sales, and enrollment calls with Medicare beneficiaries to be recorded in their entirety.

While it may sound tedious to manage recording your calls, Ritter’s in-house software development team, RIMdev, produced an easy solution. CallVault allows you to easily record and store both outbound marketing calls, from a client’s record in the Ritter Platform, and inbound calls, received at a unique generated phone number.

Not only should this help your clients feel safer, which is always the main goal, but recording your calls will also prepare you to be mindful for a secret shopping encounter.

Obtain Permission to Contact

It’s a good idea to become an expert on permission to contact (PTC), since it’s the starting point when connecting with a potential client. PTC exists to protect consumers from unsolicited outreach from agents selling Medicare products, and secret shoppers will be on the lookout for any deceitful tactics. Always remember that you must allow the beneficiary to initiate contact.

If you use business reply cards (BRCs) to connect with prospects, you should be aware that they now expire after 12 months. We recommend tracking the start and stop date within your CRM.

Secure Scopes of Appointment 48 Hours Ahead of Time

Before you meet one-on-one with a client, either in person or over the phone, you must also obtain a Scope of Appointment (SOA). In order to remain compliant, beginning for the 2024 AEP, there must be 48 hours between an SOA and the actual appointment. Exceptions to this rule include when a beneficiary is four days or less from the end of a valid enrollment period or an unscheduled walk in.

Adhere to All Other CMS Rules

Ultimately, you don’t need to worry about secret shoppers if you stay up to date and in compliance with all CMS rules. Not only do you need to be careful when it comes to SOAs and BRCs, but you also need to become familiar with the Final Rule each year.

Each year, there are new and updated Medicare marketing rules for agents. As of their 2024 Final Rule, CMS has prohibited the use of the Medicare name, CMS logo, and products issued by the federal government in a misleading way. Agents should also refrain from using superlatives, generalizing savings, and marketing benefits in areas where they aren’t available.

Now that agents are also considered third-party marketing organizations (TPMOs), they must also follow TPMO-associated compliance rules. This means your marketing and communication updates must include a standard TPMO disclaimer.

Give the Prospect Control

A great way to make a prospect feel confident and pleased is by allowing them to take control of the communication. Using direct mailers to reach potential clients puts the consumer in control and, as long as your marketing remains compliant, it will also please secret shoppers who may come across it.

Agents who partner with Ritter can also use Shop & Enroll — their own branded webpage and URL. Consumers can then navigate to your page and complete an eScope right then and there to initiate contact. Not only does this give your prospects control, but the interaction is also CMS-compliant and is recorded in the Ritter Platform.

Register with Ritter for free and get your free Shop & Enroll site!

What Secret Shoppers Look For

When you’re answering questions from any client, remember to just take your time and answer to the best of your ability. If you don’t know the answer, say that rather than giving incorrect information.

If you need some guidelines to ensure compliance during all sales, we’ve got you covered! Here are some common questions from secret shopper scorecards:

General Questions

  • Did the agent cover enrollment periods?
  • Was “free” used when referring to plan premiums or benefits?
  • Were materials distributed with a CMS approval code?
  • Did the materials display information for the current year?

All Products

  • Did the agent announce what products would be presented at the beginning of the presentation?
  • Did the agent explain the difference between Medicare Advantage and Medicare Supplement plans?
  • Were enrollment eligibility requirements discussed?
  • Was the plan’s provider network explained?
  • Did the agent review plan benefits and costs, including cost sharing?

Other Questions

  • Did the agent say they were an employee of CMS or AARP?
  • Did the agent say that any plans were endorsed by Medicare, CMS, or AARP?
  • Did the agent offer any incentives to enroll?
  • Did the agent make it clear that there is no obligation to enroll in the plan?
  • Were any non-health care related products presented?

Note: These questions are examples of some possible questions that secret shoppers may use to evaluate their interaction with agents. This list is not comprehensive.

Remember, if you do suspect someone is a secret shopper, don’t treat them differently than a consumer.

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While it may feel tedious to follow all CMS requirements, it’s important that your clients feel informed and in control at every step of the sales process. As long as you answer questions as best as you can and make an effort to put compliance first, you’ll be ready to impress.

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