10 Medicare Advantage Appointment Tips to Keep You Compliant

Updated April 4, 2024

Learning about Medicare Advantage compliance and actually selling a plan to a client in real time are two different things. I know a lot of agents are afraid of compliance and stay away from Medicare Advantage as a result.

I hope this article gives you the confidence to approach MA sales, because it's very lucrative, and it's getting more popular each year.

1. Don't be scared of compliance.

When you see the word compliance, it can be a little bit scary. 

But one underlying current I've seen from CMS as compliance rules get more strict, is they simply want transparency. The reason agents have a spotless record in terms of compliance is because they are transparent.

We don't want to deceive our clients. We want them to see all the available options. Of course, we want to make a sale, but we want the best for our clients.

CMS is really trying to pin down the agents and call centers that are trying to be deceitful and are in it for the money and not the experience of the beneficiary.

At the end of the day, don't be afraid of compliance. I view it at my friend.

Related: Top 5 MA OEP Compliance Tips

2. Work on getting prospects to call you.

Your goal as a broker is to try to get as many prospects as you can to call you. There are so many rules about making outbound calls that you just cannot use this as a way to grow your book of business.

Getting prospects to reach out to you is going to require getting involved in your community. You want to make sure your name is what people think of when they need help with Medicare.

Marketing ideas: How to Market Medicare Advantage Plans

I also recommend using branded marketing materials from Medicare Advantage carriers, as they're compliant and can be specific in terms of plan benefits. Most carriers have flyers, brochures, postcards, social media posts, presentation slides, and emails.

Example of a Humana marketing piece

You can make unique marketing materials, but there are an unbelievable amount of hurdles to get that done.

Read More: The 5-Star Enrollment Period: Marketing Tips for Medicare Advantage Agents

3. Get familiar with outbound call rules.

Once you know the compliance rules, there's really nothing to be afraid of.

Here are a few pointers on what you can and cannot do when it comes to outbound calls.

YOU CAN:

• You can call current enrollees, including those in non-Medicare products, to discuss plan business.
• You can return phone calls or messages.
• You can call when you get permission, such as from a business-reply card or an email requesting a return call.

YOU CAN'T:

• You can't make unsolicited phone calls to prospective enrollees.
• You can't call about other business as a way to generate Medicare leads (bait and switch).
• You can't call referrals – the referred person needs to call you.
• You can't call someone who attended a sales event unless they gave express permission for a follow-up call, and you need documentation of that.
• You can't call prospective enrollees to make sure they received something you mailed to them (i.e: did you get my postcard?)

4. Recite the TPMO disclaimer at the beginning of your appointment or call.

Within the first 60 seconds of a phone call or appointment, be sure to recite the TPMO disclaimer, which is as follows:

“We do not offer every plan available in your area. Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. Please contact Medicare.gov, 1‑800‑MEDICARE, or your local State Health Insurance Program to get information on all of your options.”

In the rare case that you actually offer all available plans in your service area, you'd use this disclaimer:

“Currently, we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. You can always contact Medicare.gov, 1‑800‑MEDICARE, or your local State Health Insurance Program for help with plan choices.”

5. Record your phone calls.

The recording requirement went into effect on October 1, 2022, and it applies to enrollments made for a January 1, 2023 effective date and beyond.

Make sure to record your phone calls in order to stay compliant. Please note that the entire chain of enrollment must be recorded.

In-person appointments do not need to be recorded, but Zoom or video conference calls do.

6. Cover plan specifics during an enrollment call.

If you're doing an enrollment over the phone, make sure you cover plan specifics, including:

• Premium, deductible, MOOP
• Are referrals required?
• Covered medical and hospital benefits
• Prescription drug coverage, including prior authorizations, coverage gap, formulary, and network
• Extra benefits
• Optional supplemental benefits
• Network
• Star Rating

Compliant close options include:

• "If you are ready to enroll, I will help you complete the application."
• "All I need is your Medicare card, and I can enroll you now."

More on this topic: How to Sell Medicare Advantage Over the Phone

7. Utilize MedicareCENTER to help you stay compliant.

MedicareCENTER is a great tool to help you stay compliant. I cannot rave enough about it.

This software is constantly getting upgraded. It includes:

• Call recording functionality
• The TPMO disclaimer listed on the screen every time you make a call
• Enrollment software
• CRM included

If you need help recording your calls and referencing the disclaimer at the beginning of each call, this software is going to make your life a lot easier.

Hear From 6 Agents – Their MedicareCENTER Experience During AEP

8. Encourage prospects to do an in-person appointment.

If you're in a position where you can encourage a prospect to come to your office or any kind of in-person setting, I would highly suggest it.

It's always better to be face-to-face with a client to develop a relationship, and you don't have to worry about recording a call when you're in-person.

9. Find out what your prospect values in a health plan.

Many prospects come to me saying things like, "My friend has this Aetna plan, and he really likes it. I want it, too."

I like to answer that by asking questions like, "Is there anything in particular about that plan that interests you?"

This opens up the discussion so I have a better understanding of what that prospect is looking for.

Maybe their friend said the company is really great about paying their claims, so you know that's an important consideration. Whatever the case may be, be inquisitive so you can best serve that beneficiary.

10. Consider doing a Medicare Advantage sales seminar.

Another great way to enroll prospects in Medicare Advantage plans is to hold a sales seminar. It may sound daunting, but we have a full guide on our blog about how to hold a compliant sales seminar.

If there is a plan in your county that's very competitive on every front, there's a good chance it's a fantastic fit for many individuals. Holding a sales seminar and going through the details of that plan is a great way to educate and enroll many individuals at the same time.

In addition, many Medicare Advantage carriers have reps that are willing to go to your sales seminar and actually help you present. If you're really worried, they may even do the presentation for you! 

Please note that for a sales seminar where you actually complete enrollments, you can only present one plan at a time.

Conclusion

There is such a wonderful opportunity in Medicare Advantage sales, and with more individuals seeking it out each year, now is the time to get comfortable.

Don't let compliance be a hurdle! If you have any questions, please don't hesitate to reach out to me. You can request a consultation by clicking the banner below, and I'll give you a call.

Lastly, we would love the opportunity to earn your Medicare Advantage business. Please check out the MA carriers we have, and request contracting if you'd like to work with us.

Related: Ultimate Scope of Appointment (SOA) Guide for Medicare Agents