Medicare Agent Compliance Center

Be ready for the plan and the state

• Hold the required active resident/nonresident health insurance license in every state where you solicit, discuss, or enroll. Maintain carrier appointments wherever state law requires them.
• Complete the current annual Medicare training and testing required by the plan and CMS, plus each carrier’s product-specific certification and any required state or agency training. Do not assume last year’s certification carries forward.
• Sell only products for which you are contracted, appointed, certified, and authorized. Verify the specific plan, county/service area, contract/PBP, and sales channel before presenting it.
• Use only the carrier/agency systems and approved scripts, applications, comparison tools, and marketing pieces you are authorized to use. Keep credentials private; never let another person submit under your login.

Recommend based on the beneficiary’s needs

Evaluate available choices objectively. Compensation, production goals, carrier relationships, bonuses, or personal preferences must not interfere with recommending the plan that best fits the person’s needs. Do not promise enrollment compensation, gifts, or other value in exchange for choosing a plan.

Disclose your role and which organizations/plans you represent. If you do not represent every plan in the area, do not imply that you compared every option. Direct beneficiaries to Medicare.gov or 1-800-MEDICARE for the full market.

2026 AEP for coverage effective January 1, 2027

CMS’s 2027 enrollment guidance states that prospective-year marketing may start October 1, but AEP enrollment cannot occur until October 15. A paper application that a beneficiary independently sends to a plan before AEP may be handled under special plan rules; an agent may not solicit, collect, or route that early application. Do not rely on this narrow exception as an agent workflow.

Other election periods: verify the person’s specific eligibility

• Initial Coverage Election Period (ICEP)/Initial Enrollment Period: timing depends on when the person becomes entitled to Part A and enrolled in Part B and the type of coverage sought.
• Special Enrollment Period (SEP): a specific qualifying event or status is required. Ask neutral questions, identify the applicable SEP category, confirm the effective-date rule and evidence/documentation instructions, and follow the carrier’s process. Do not coach someone to claim an event that did not occur.
• MA OEP: applies to individuals currently enrolled in MA. It does not authorize general marketing to all Medicare beneficiaries as if it were another AEP.
• 5-Star SEP, institutional, dual-eligible, loss/gain of coverage, move, disaster, and other SEPs: each has distinct eligibility, frequency, plan-type, timing, and effective-date rules. Verify current CMS guidance and carrier system validation.
• Medigap: federal/state guaranteed-issue and open-enrollment rules differ from MA/PDP election periods. Never tell a person that an MA election automatically guarantees Medigap acceptance.

Use permission-based outreach

CMS restricts unsolicited contact. For MA and Part D marketing, do not cold-call, robocall, text, leave voicemail, send unsolicited social-media direct messages, approach people in common areas, or go door-to-door. CMS treats calls based on referrals and calls to sales-event attendees as unsolicited unless the beneficiary gave the required express permission. A beneficiary’s request or consent can make a return call permissible; keep the request/consent and honor its limits.

• Unsolicited direct mail and email are generally permitted subject to applicable requirements; marketing email must include an effective opt-out mechanism.
• Do not turn a non-Medicare product relationship, a referral, a purchased lead, or an event attendance list into permission to make Medicare sales calls unless the required permission exists.
• Do not treat a business card, sign-in sheet, public directory listing, or data vendor’s assertion as proof of permission. Confirm what the person requested, which entity may contact them, by which methods, and for what purpose.
• Follow applicable federal and state telemarketing, do-not-call, consent, texting, privacy, and recording laws in addition to CMS and carrier rules.

Do not share beneficiary data between TPMOs without specific written consent

Personal beneficiary data collected by a TPMO for Medicare marketing or enrollment may only be shared with another TPMO after prior express written consent. The disclosure must clearly identify each receiving TPMO and let the person accept or reject sharing with each entity individually. A vague blanket checkbox, hidden disclosure, pre-checked box, or consent that fails to identify each recipient is not a safe substitute.

Collect only information needed for the stated purpose. Do not sell, transfer, upload, or expose beneficiary information to a lead buyer, partner, downstream agent, or unrelated business unless the sharing is legally permitted and the required consent and plan instructions are satisfied.

Agree on the scope before a personal marketing appointment

A personal marketing appointment is an individualized meeting to discuss Medicare plan marketing, regardless of whether it is in person, by phone, or virtual. Before the appointment, agree on and document the Scope of Appointment with the beneficiary. For an in-person appointment, the SOA must be in writing. Use the current carrier/agency form or compliant recorded process and retain the documentation.

• Identify the beneficiary and agent and the product types the person agreed to discuss. Keep the scope specific enough to guide the meeting.
• Discuss only the product types within the documented scope. If the person wants to discuss an additional health-related line, stop and obtain a new/separate scope before marketing it.
• Beneficiary-initiated questions outside the scope do not authorize an unplanned sales presentation; pause and document/expand the scope as required before continuing marketing discussion.
• A request for information/SOA may generally remain valid for up to 12 months under the regulation; confirm the current plan form and whether the request still reflects the person’s interest.
• Do not pressure someone to sign an SOA or imply that signing commits them to enrollment. The SOA is permission to discuss listed product types, not an application.

48-hour rule: do not present a 48-hour waiting period as a universal current federal CMS requirement. Federal SOA timing has changed over time; follow the current regulation and any stricter carrier or Advantage Plus appointment rule in effect. Never waive a carrier rule because the federal rule may be less restrictive.

Make every statement accurate, balanced and supportable

• Use current plan-year and service-area information. Clearly distinguish plan benefits, eligibility criteria, limitations, service areas, providers, pharmacies, premiums, and out-of-pocket costs.
• Do not say or imply that a plan is “Medicare,” “government-issued,” “endorsed by Medicare,” or the only/best plan unless the statement is accurate, substantiated, and approved. Never use CMS or Medicare logos in a way that implies endorsement.
• Do not mislead through headlines, omissions, fine print, atypical examples, outdated benefits, misleading comparisons, or unsupported savings claims. Avoid absolute words such as “free,” “everything covered,” “guaranteed,” or “everyone qualifies” unless the full statement is true and appropriately qualified.
• Do not promise provider participation, prescription coverage, a specific cost, benefit amount, or enrollment acceptance without checking current official plan information for that person’s county and circumstances.
• Use carrier-approved and CMS-filed materials where required. Do not edit approved material, build a new advertisement, use a carrier logo, or publish an agent-created comparison as official plan content without required review/approval.
• When using social posts, landing pages, email, direct mail, print, radio, video, text, or digital advertising, include required disclaimers in the appropriate readable/understandable format; retain approval and version records.

TPMO disclaimer: use current plan- and area-specific counts

A TPMO that markets or sells MA/PDP products on behalf of more than one organization must use the required TPMO disclaimer. The wording depends on whether the organization represents every MA organization in the service area. Current 42 CFR language calls for the number of organizations and products represented in the area. Verify the applicable approved wording and current counts with Advantage Plus/carrier compliance; do not copy an old national “we do not offer every plan” paragraph or invent counts.

Under the current rule, the disclaimer must be spoken during sales calls before benefits are discussed, shown in electronic communications, prominent on TPMO websites, and included in TPMO marketing materials. Read/display it clearly; do not bury it in a footer or truncate required language. Carrier-approved wording and delivery instructions take precedence where stricter.

Other required statements depend on the content

• Federal Contracting Statement: plan marketing materials generally need the plan’s legal/marketing name, plan type, statement of contract with Medicare (and, when applicable, the state Medicaid program), and statement that enrollment depends on contract renewal; specified material types are excepted by regulation. Use the plan-approved version.
• Star Ratings: when Star Ratings are mentioned, use the required rating disclaimer/content and identify the applicable contract/rating year correctly.
• SSBCI: if marketing special supplemental benefits for the chronically ill, include the required chronic-condition eligibility and coverage qualification disclosures. Do not imply that all members qualify.
• Events/accessibility: invitations to covered events must include the required accommodations statement/contact details as applicable.
• Out-of-network or provider claims: use the plan-required disclaimer when applicable; confirm the current wording and whether a cited provider is actually in network.
• Dual-eligible/SNP materials: use required Medicaid, eligibility, model-of-care, and other plan-specific disclaimers. Avoid implying that Medicare or Medicaid pays cash directly to the beneficiary.

Official model and standardized content is in 42 CFR § 422.2267 and the parallel Part D rule.

Make materials understandable and accessible

• Use clear, readable material and the carrier-approved versions of CMS standardized/model content. Do not rewrite standardized CMS text except for the permitted fields/edits allowed by the rule.
• Follow the CMS and carrier requirements for minimum type size, required content, readable disclaimers, language translation, accessible formats, and timing. Make required non-English and accessible-format materials available when required or requested; do not assume one English PDF meets every need.
• Provide reasonable communication access in the interaction, including interpreter or accessible-format support as appropriate and permitted. Use the plan’s approved TTY/accessibility contact information when required.
• Plan-filed materials, model language and agent-created advertising have distinct review rules. Route new or materially changed marketing materials through Advantage Plus/carrier review before use, and keep the approved version.

Do not shrink required disclaimers, hide them behind a link, crop them from an image, or use low-contrast text to fit more content. The eCFR rules distinguish standardized material, model material, and other marketing content; use the plan-approved layout.

Keep unrelated products out of Medicare sales activity

Do not use a Medicare marketing appointment or event to cross-sell non-health products such as life insurance, annuities, auto/home coverage, or other unrelated financial products. Do not condition Medicare enrollment assistance on buying another product. If a beneficiary separately asks about another line, follow the applicable CMS restrictions, carrier policy, state law, and Advantage Plus procedure; keep the transaction distinct and obtain any required new permission, scope, and approvals.

Keep educational and sales events clearly separate

If a sales event follows an educational event, clearly announce that the educational session is ending and a sales event is beginning, and give attendees enough opportunity to leave before sales activity starts. Advertise each event accurately.

Food, gifts and location-specific rules

Do not offer cash or cash-equivalent inducements for enrollment. Gifts must comply with the current nominal-value standard and plan/agency policy; do not condition a gift on attending a sales presentation, providing personal data, or enrolling. CMS allows only limited refreshments/light snacks at marketing events; meals are prohibited at marketing/sales events where plan-specific benefits are discussed. Follow the plan’s current dollar limits and event instructions—do not infer an allowed amount from an old handout.

Special rules apply in healthcare settings and long-term-care facilities. Do not approach residents in common areas or conduct unsolicited facility visits; appointments in long-term-care settings should be at the resident’s request. Obtain facility permission and follow privacy, access, and carrier requirements.

Special restrictions in provider offices and healthcare settings

Do not treat a physician’s office, clinic, hospital, pharmacy, or long-term-care facility as an ordinary sales venue. Provider and plan-initiated activities have specific limits under 42 CFR § 422.2266.

• Providers generally may make objective information and communications material available, and marketing material/application forms may be placed in common areas under the rule. Do not display or distribute plan marketing material or enrollment forms in areas where care is being delivered except where the regulation allows communications material.
• A provider acting at a plan’s request may not collect SOAs or enrollment applications, urge a patient into a specific plan because of financial or other interests, offer enrollment inducements, conduct marketing health screenings, or receive compensation for marketing/enrollment activity.
• Do not use a provider’s patient list or referral as permission to make sales contact. Follow the beneficiary-contact rules and obtain valid permission where needed.
• For long-term-care facilities, do not enter a resident’s room for marketing unless the beneficiary or authorized representative initiated/authorized the contact under the rules; facility policies and resident privacy still apply.

Complete CMS’s 2027 pre-enrollment discussion

Before beginning an MA or Part D enrollment, discuss and document the beneficiary-specific items in the 2027 CMS Agent and Broker Training & Testing Guidelines. This is a required pre-enrollment discussion, not just a general recommendation:

1. Plan preference: ask what kind of coverage the person wants, such as lower premium with higher copays or a higher premium with lower cost sharing.
2. Providers and facilities: check current primary care providers, specialists, preferred hospital, and other preferred facilities in the plan directory. If a needed provider or hospital is out of network, explain the implications and discuss choices.
3. Pharmacy and prescriptions: confirm the person’s current pharmacy is in network; if not, explain that they may need to choose another pharmacy. Check each current prescription against the formulary and explain that a non-covered drug may require the person to pay the full price, subject to applicable exceptions and plan processes.
4. Healthcare needs: ask whether the person needs dental, vision, or hearing coverage and discuss costs and limits. Ask about other needs such as durable medical equipment, physical therapy, or other specific services.
5. Premiums and cost sharing: review applicable plan premiums (including the Part B premium information identified in CMS guidance), deductibles, copayments, coinsurance, and the cost of services/items the person expects to use. Compare the current premium with the new premium when relevant.
6. Network and travel: explain how out-of-network services work for the specific plan type and what coverage is available outside the United States. Do not describe emergency or urgent-care exceptions as routine out-of-network coverage.
7. Current coverage impact: explain how enrollment can affect other coverage and may disenroll the person from another MA plan or affect Medigap. Clarify that MA is a full health plan, not simply a dental/vision/hearing add-on or rider.
8. Plan rules and changes: explain that plan benefits may change on January 1, that the Evidence of Coverage (EOC) contains the plan’s costs, benefits, and rules, and how the beneficiary can file a complaint.
9. Cancellation: explain the beneficiary’s right to cancel the enrollment request and the specific date by which cancellation may occur for that enrollment.
10. Special plan eligibility: explain applicable eligibility conditions: C-SNP requires a qualifying chronic condition; D-SNP requires qualifying Medicaid status; I-SNP requires the applicable institutional level-of-care eligibility. For an MSA, explain the requirement to maintain the required trust/custodial account. Review PPO/PFFS out-of-network terms when applicable.

Do not use a scripted “yes” as a substitute for discussion. Verify network and drug information using current carrier tools and explain what was checked. Do not guarantee that a provider will remain in network, a medication will remain covered, or a claim will be paid; the current EOC, provider directory, and formulary govern.

Protect the person’s choice and access

• Do not pressure, intimidate, misrepresent, or repeatedly contact a beneficiary who declines. Do not tell a person to cancel current coverage until the new enrollment is accepted and the consequences are understood.
• Do not knowingly enroll someone into duplicate or incompatible coverage, a plan outside their service area, or an SNP for which they are not eligible.
• Do not discriminate based on health status, disability, race, ethnicity, language, age, or other protected status; do not discourage people with higher healthcare needs from enrolling.
• Use qualified interpreters or accessible communication supports when needed and permitted; speak to the beneficiary, not over them. Confirm that the enrollee understands key consequences and can communicate their decision.
• When working with an authorized representative, confirm authority and complete the form/recording fields required by the plan. Do not sign for the beneficiary or treat a caregiver as legally authorized without verification.

Obtain the beneficiary’s own, informed enrollment request

• Use the correct, current CMS/carrier-approved application and submission route for the plan and election period. Check eligibility and service area before completion.
• The beneficiary must make an affirmative choice and complete the required signature/authorization step. Explain that the request is to enroll in the named plan and explain the requested effective date and any replacement of current coverage.
• Never pre-sign, forge, copy/paste, alter, or add a signature; never sign for someone because they are unavailable or have difficulty writing. Follow the plan’s authorized-representative, witness, and alternative-signature procedures.
• Do not use a family member’s consent as the beneficiary’s consent unless that person’s legal authority is established under the plan procedure.
• For electronic signatures, use the plan’s authorized system and authentication workflow. A typed name, unchecked box, agent-entered name, or emailed image is not automatically a valid e-signature.
• For telephonic enrollment, use the plan’s approved recorded process; capture all required disclosures, attestations, choice, election period, and signature substitute. Do not submit a call recording or agent notes in place of the carrier’s required telephonic enrollment record unless that is the plan-approved mechanism.

Get the application date and timing right

CMS rules define application dates by submission method and election period. For a standard paper request, the date the plan first receives it is generally the application date; electronic, web-based, and telephonic enrollment processes use their applicable completion/call date rules. There are special timing rules for certain AEP paper requests received before October 15. Use the carrier’s timestamped system and current enrollment guidance—never backdate, change, or select a date to force eligibility or an effective date.

Before sending, review the form for required fields, signature/authorization, requested plan, election period, contact information, and any required supporting documentation. Correct mistakes transparently through the plan’s process. Do not complete answers for the beneficiary based on assumptions.

If a request is incomplete, follow the plan’s prompt outreach and completion procedure. Never represent a partial application as accepted or guarantee enrollment until the carrier/CMS confirms it.

Signature method, representative authority & incomplete applications

CMS’s CY 2027 enrollment guidance identifies the signature element by submission method: paper requests use a pen-and-ink signature; telephone requests use a verbal attestation of intent to enroll through the approved recorded process; electronic requests use an electronic signature or a clear, distinct affirmative step such as activating an “Enroll Now” or “I Agree” button. Follow the carrier’s approved process and capture every required field. A name typed into a form is not automatically enough unless the approved electronic workflow makes it a valid signature/affirmative act.

The beneficiary or a legally authorized representative may complete the request as allowed by the application and plan procedure. If a representative acts, accurately record the representative’s identity, relationship, authority, and attestations. Agents may explain the form but may not sign, attest, select a plan, or certify the applicant’s answers for them.

Incomplete request handling: the plan—not the agent—must check whether missing information is available through CMS systems and, if not, notify the beneficiary within 10 calendar days that more information is needed. The plan generally gives 21 calendar days to provide it, but election-period-specific cutoffs also apply. Help the beneficiary respond promptly through the plan’s approved channel, monitor status, and do not promise acceptance. CMS requires plans to document their completion efforts and send a denial notice within the prescribed timeframe if the request remains incomplete or the person is ineligible.

Record and retain covered marketing and sales calls

Under the current MA TPMO rule, all marketing and sales calls—including the audio portion of calls conducted through web-based technology—must be recorded and retained in their entirety for at least 6 years. Audio must be kept for the first 3 years. For years 4–6, the record may be kept as audio or as a complete and accurate transcript. Similar requirements apply under the Part D regulation.

• Confirm recording is active before the marketing/sales interaction begins; preserve the entire call, including required disclaimers, scope discussion, needs review, plan presentation, enrollment request, and attestations when applicable.
• Do not pause, edit, splice, delete, or selectively retain parts of a recording. Keep recordings/transcripts linked to the correct beneficiary, date, agent, plan, and enrollment record.
• Follow any state all-party consent and carrier notice requirements. If someone objects to recording, do not continue a sales call in a prohibited unrecorded channel; follow the approved alternative process or end/reschedule.
• Maintain secure access controls and retrieve records promptly for an authorized compliance review or audit.

Telephonic enrollment calls need more than a recording

A general sales-call recording is not automatically a valid enrollment. Use an approved telephonic enrollment process that contains the plan-required disclosures and captures the beneficiary’s clear intent, plan selection, eligibility/election-period information, attestations, representative details where relevant, and the required signature substitute. The call date may serve as the application date under the approved telephonic process. Review the current carrier script and system workflow before using it.

Never record a beneficiary through a personal device or consumer app outside the approved secure system. Never tell the beneficiary that a recorded conversation automatically enrolls them unless the required telephonic enrollment process has been completed.

Handle Medicare information carefully

• Collect only the information needed to complete the requested task. Explain why sensitive information is needed and use the approved secure enrollment or carrier system.
• Do not send Medicare Beneficiary Identifiers, Social Security numbers, diagnoses, medication lists, application forms, or call recordings through personal email, unapproved messaging, public links, or shared devices.
• Do not store beneficiary documents in personal cloud drives, photos, or unsecured downloads. Protect screens and printed material; verify the recipient before transmitting; delete local copies under approved retention procedures.
• Do not disclose one beneficiary’s information to another agent, family member, provider, or plan without a valid authorization or other permitted basis.
• Report misdirected documents, lost devices, unauthorized portal access, suspected phishing, or improper data exposure immediately through Advantage Plus and the carrier’s incident process. Preserve evidence; do not independently conceal or delete the record.

Privacy obligations may arise from plan contracts, HIPAA relationships, state law, and other rules. Do not assume every independent agent is a HIPAA-covered entity, but always follow applicable contracts and privacy/security instructions.

Close the loop without overpromising

• Give the beneficiary a copy or confirmation of the submitted request through the approved channel and explain how to check status.
• Tell the beneficiary that submission is a request; enrollment is not final until accepted/confirmed by the plan/CMS. Do not promise a card, provider access, benefit approval, or effective date ahead of confirmation.
• If the application is rejected, incomplete, duplicated, or submitted under the wrong election period, contact carrier enrollment support and follow its correction process. Do not submit a replacement request that conflicts with the beneficiary’s intent.
• Explain that a valid later election may replace an earlier election under CMS rules. Encourage the beneficiary to review plan notices and contact the plan promptly if the plan or effective date is not what they requested.
• Do not cancel current coverage or tell the person to stop using current care/medication based solely on an agent’s submission receipt.

Keep a clear, complete file

Follow the plan and Advantage Plus record schedule, and preserve the records required by CMS, contract, state law, and litigation holds. An enrollment record has separate retention requirements that may extend to 10 years. Retain only through approved secure systems.

• Contact/lead source and proof of permission to contact.
• SOA and any updated scope; appointment date, product types, and notes on beneficiary requests.
• Needs-review details: provider/specialist, pharmacy, prescriptions, costs, plan fit and important limitations discussed.
• Materials used, version/approval evidence, plan comparisons, and any required disclaimer delivery.
• Completed application and signature/attestation; election-period basis and supporting documents where required.
• Submission receipt, timestamps, carrier response, corrections, and beneficiary follow-up.
• Call recordings or transcripts and any written complaint or escalation, retained according to the correct schedule.

Write factual, contemporaneous notes. Do not alter earlier notes to make a file look complete; add a dated correction or addendum that explains the change.

Escalate concerns promptly

Report suspected unauthorized enrollment, misleading sales activity, privacy incidents, forged signatures, unapproved marketing, pressure, inappropriate contact, or a plan/carrier systems issue to the appropriate Advantage Plus compliance contact and carrier channel promptly. Include dates, parties, plan, and supporting records. Preserve the original evidence and cooperate with authorized reviews.

• I am licensed, appointed, trained, certified, and authorized for this state, carrier, plan, and channel.
• The beneficiary requested/consented to this contact; the contact method and lead source are permitted.
• I documented an accurate SOA before the personal marketing appointment and will stay within scope.
• I am using current, approved 2027 information and delivering the applicable TPMO/plan disclaimers.
• I verified the beneficiary’s providers, pharmacy, prescriptions, costs, healthcare needs, and plan eligibility.
• The beneficiary understands the plan choice, effective date, limitations, and what existing coverage may change.
• The election period is valid today; I am not soliciting/accepting an AEP election before October 15.
• The beneficiary completed the application and personally provided the required signature/authorization or valid representative attestation.
• Required call recording is active; I am using the plan-approved enrollment channel and script.
• I submitted accurately, saved proof, explained that acceptance is pending, and will follow up securely.