Senior Insurance Leads maintains its commitment to staying in compliance with the applicable laws and regulations.  Since the publication of the new CMS MA/MAPD Marketing Guidelines on September 15, 2008 and further clarifications published by CMS on October 8, 2008, we have received many inquiries about the ability to set in-home appointments for Medicare Advantage in the 2009 AEP/OEP from agents who have seen success using our pre-set Medicare Advantage appointments in the past.

It is always important to conduct business in an ethical way and stay in compliance. This year it's especially important given the increased level of scrunity around Medicare Advantage marketing practices.  The good news is that we still have options for marketing senior health related products effectively this year. SIL has constructed our process to stay in compliance and to keep the agents in compliance as well. 

Please review the below interpretations while noting that it doesn't constitute legal advice but merely represent our understanding of the MIPPA and CMS Guidelines based on a legal review.  When ready, please proceed to the product pages of our to learn about Medicare Supplement Appointment or Medicare Coverage Options Review Appointment (MCOR).

Please Contact Us in case you need additional help upon reading the below FAQ's before placing an order.

 1.  Cold Calls Prohibited. 

The new Rules prohibit Medicare Advantage organizations and Part D sponsors and their agents, brokers, or producers (“producers”) from going door-to-door, making “cold calls,” or in any way making “direct contact” with a prospect, unless the prospect initiates the contact. 

This requirement applies to Medicare Advantage and Part D products only, however, so Medicare Supplement, dental, and other health-related products are unaffected at the federal level.  (Note that state laws vary and this analysis does not address state laws.)  Producers (or lead generation services acting on their behalf) may therefore make cold calls to prospects concerning Medicare Supplement, dental, and other health-related products from a federal regulation perspective.

2.         Scope of Appointment. 

A producer for a Medicare Advantage organization or Part D sponsor must gain a prospect's agreement to the scope of a marketing appointment prior to meeting with the prospect.  This rule would apply to other products (such as dental, vision and/or Medicare Supplement plans) that are offer by an organization which also markets MA/MAPD plans. 

Accordingly, a producer selling products for a Medicare Advantage organization or Part D sponsor must establish the scope of a meeting with a prospect prior to the meeting, even if the scope is for Medicare Supplement, dental, or other products that are not related to Medicare Advantage or Part D.  

2.         Educational Events. 

A broker should be able to set up an educational appointment (which involves no discussion of specific products) based on a cold call.  If the prospect is interested in learning about specific products, the broker needs to leave a business card (and no other material) and ask the prospect to call to set up an appointment.  Once the prospect calls, the broker must establish the scope of the appointment and RECORD THE CONVERSATION to document the prospect's agreement to the scope of appointment.  If the broker cannot record the call, the broker needs to send a scope of appointment form (that has been approved by the broker's Medicare Advantage Plan) to the
prospect, have the prospect fill it out and return it PRIOR TO THE APPOINTMENT. 

Although the appointment does not have to be 48 hours after the options review appointment, there will be substantial delay between appointments, because of the requirements that the prospect call to request an appointment and that the broker document the prospect's agreement to the scope of the appointment.
 
2.         Medicare Supplement Meeting.   

A broker may set an appointment to discuss Medicare Supplement Coverage with a prospect based on a cold call.  If the prospect expresses an interest in Medicare Advantage products, the broker may provide the prospect a scope of appointment form (that has been approved by the broker's Medicare Advantage Plan) and have the prospect complete and sign the form.  The broker may then set an appointment with the prospect to discuss the products identified in the scope of appointment form.
 
If the broker covered products in the Medicare Supplement Meeting that are offered by the same company that offers the Medicare Advantage products the broker will cover, the 48 hour rules applies to the Medicare Advantage appointment.  If the Medicare Supplement Meeting covered only products offered by companies other than the company offering the Medicare Advantage products, the 48 hour rule does not apply.  In other words, when the broker is selling Medicare Supplement products and Medicare Advantage products for Company X, the 48 hour rules applies.  But, if the broker is selling Medicare Supplement products for Company X and Medicare Advantage products for Company Y,
the 48 hour rule does not apply.

Note from Senior Insurance Leads:   All SIL customers are advised to download and use a CMS-approved Sales Appointment Confirmation Form in case they plan to market a CMS-regulated product.