Marketing rules for Medicare health & drug plans
Medicare has rules about how plans and their representatives can contact you and market health and drug plans. Understanding these rules can help you spot when a plan or their representative is doing something Medicare doesn’t allow.
General marketing rules for Medicare health and drug plans
Medicare health and drug plans and their representatives (including independent agents and brokers) aren't allowed to:
- Ask for your personal financial information (like bank account or credit card numbers) over the phone or in-person just to give you a quote.
- Come to your home uninvited to sell you something.
- Call or text you, unless you’re already a member of the plan or you gave them permission to contact you by phone or text.
- Require that you speak to a sales agent to get information about the plan.
- Offer you cash, gifts worth more than $15, or free meals as an incentive to join the plan.
- Ask you to pay over the phone or online. The plan must send you a bill.
- Venderle un producto que no esté relacionado con la salud; como por ejemplo, una póliza de seguro de vida o anualidad como estrategia comercial para vender un plan de salud o de medicamentos.
- Make an appointment to tell you about the plan unless you agree to the meeting and complete an appointment form. During the appointment, they can only discuss the products you agreed to hear about.
- Talk to you about the plan in areas where you get health care (like an exam room, hospital patient room, or at a pharmacy counter).
- Market plans or enroll you in a plan during an educational event like a health fair or conference. (Note: A marketing event can immediately follow an educational event, but the representative must tell you the educational event ended and give you a chance to leave before the marketing begins).
- Advertise to you without using the specific plan type (like HMO or PPO) in the plan name.
- Use inaccurate, misleading, or confusing information or images in marketing or communication materials, including misleading use of the CMS logo, Medicare logo, or Medicare card.
- Discuss specific plan benefits with you before telling you the number of organizations they represent and how many plans they offer in your area. They must also refer you to Medicare.gov or 1-800-MEDICARE (1-800-633-4227) for information about all your options or help choosing a plan. TTY users can call 1-877-486-2048.
Rules that agents & brokers must follow when meeting with you
Independent agents and brokers selling plans must be licensed by your state. Plans must tell your state which agents are selling their plans. If you meet with an agent or broker, they must follow the rules above and the additional rules listed below.
During the meeting, the agent or broker can:
- Entregarle material acerca del plan.
- Explain plan options.
- Entregarle un formulario de inscripción.
- Recopilar el formulario de inscripción completo.
- Give you their business card.
During the meeting, the agent or broker can't:
- Charge you an enrollment fee.
- Steer you toward a particular plan.
- Give you inaccurate or misleading information about the plan.
- Tell you about other plan options you haven't agreed to discuss, unless you specifically ask about them and complete a separate appointment form.
- Pressure you to join a plan.
Ask you to sign an enrollment form before you’re ready.
Después de la reunión:
- A plan representative may contact you to make sure you want to join and you understand how the plan works.
- The agent or broker you met with can call you to talk about other plan options.
Are there different rules for agents or brokers selling Medicare Private Fee-For-Service (PFFS) Plans?