When holding a Medicare sales marketing event, there is often a lack of understanding regarding what can be done. Because the CMS (Centers for Medicare & Medicaid Services) has set strict regulations, health plans and agents must comply with specific guidelines that allow them to talk to beneficiaries at all without breaking any rules.
What Is a Medicare Marketing Event?
Before we get into what is permitted, let’s make it clear what a Medicare marketing event is. These events are intended to publicize Medicare Advantage (MA) plans, Prescription Drug Plans (PDP), and other Medicare-related benefits. They may be educational seminars, ad hoc cocktail parties, or formal sales presentations.
Medicare marketing events are one way of letting potential beneficiaries know about plan choices. Nevertheless, they are severely regulated by Medicare rules because abuse or misrepresentation often occurs in the course of such events.
Understanding CMS Guidelines
The CMS outlines clear rules for marketing practices at Medicare sales events to safeguard beneficiaries from coercion or confusion. Violating these rules can lead to sanctions, fines, or contracts being terminated. Below, we’ve outlined the overarching principles to ensure compliance.
Educational vs. Sales Events
One of the most important distinctions you need to understand is the difference between educational and sales events.
- Educational Events
These are designed to provide general information about Medicare, health options, and enrollment. No specific plans can be marketed, and no enrollment applications can be distributed or accepted.
- Sales Events
These presentations introduce specific plans. Enrollment forms may be distributed and completed at these events, provided they comply with CMS rules.
It’s essential to clearly state whether your event is educational or sales-based, as mixing elements of both can lead to non-compliance.
What Is Allowed at Medicare Marketing Events?
Here’s a breakdown of what you can do during a Medicare marketing event under CMS regulations.
1. Provide Plan-Specific Information (Sales Events Only)
At a sales event, you’re allowed to discuss details about specific Medicare plans, including premiums, benefits, and coverage options. For example, you might highlight a plan’s prescription drug coverage or explain its network of providers.
However, ensure that the information is factual and avoids misleading beneficiaries. Use approved marketing materials provided by the plan sponsor and refrain from exaggerating plan benefits.
2. Collect Contact Information
At sales events, you can collect beneficiaries’ contact information, but it must be voluntary. For example, attendees can provide their phone number via a sign-up sheet or raffle card if they choose. Coercing attendees into providing their information is prohibited.
3. Offer Giveaways
You’re allowed to distribute giveaways, but there are strict rules about their value and purpose. Items must meet the following criteria to ensure compliance:
- Nominal Value: The CMS defines nominal value as $15 or less per item.
- Non-Cash: Cash or cash-like items, such as gift cards or vouchers, are prohibited.
- Unconditional Distribution: Everyone who attends the event must receive the giveaway with no strings attached.
Examples of compliant giveaways include branded pens, tote bags, or reusable water bottles.
4. Accept Enrollment Applications
If your event is a sales presentation, you can provide and accept enrollment forms from attendees. Make sure participants fully understand the forms before completing them and avoid pressuring anyone to enroll.
5. Answer Questions and Provide Clarifications
Attendees often have detailed questions about plans, coverage, or their Medicare eligibility. You’re encouraged to answer questions as long as your responses are accurate and align with CMS’s rules.
6. Provide the Scope of Appointment
For one-on-one discussions, a Scope of Appointment (SOA) form must be completed before discussing Medicare plans. This outlines the types of information the attendee has consented to discuss. Ensure this is filled out correctly to remain compliant.
7. Hold Events in Permitted Locations
Medicare marketing events should be held in compliant venues. For example, community centers, libraries, or restaurants are typically acceptable locations. However, you generally cannot host events in places where care is provided, like doctors’ offices or pharmacies.
Tip: Always review the venue’s policies and confirm that the location complies with CMS marketing guidelines.
What Isn’t Allowed at Medicare Marketing Events?
Equally important to understanding what’s allowed is knowing what you must avoid during marketing events. Here are some common practices prohibited under CMS rules.
1. Cold-Calling or Pressuring Attendance
CMS prohibits unsolicited contact with Medicare beneficiaries. This means you cannot cold-call, send unsolicited emails, or show up uninvited at someone’s home to promote your event.
2. Misleading Marketing Tactics
Avoid using language or marketing practices that may confuse or mislead beneficiaries. For example:
- Superlatives like “the best Medicare plan” are not permitted.
- Don’t pressure attendees or imply that they must enroll.
- Avoid stating that plans are endorsed by Medicare or the government.
3. Discussing Unapproved Benefits
Only communicate CMS-approved information during your presentation. This ensures consistency and helps beneficiaries make an informed decision.
4. Conditional Giveaways
As mentioned earlier, giveaways must be provided to all attendees without conditions. Prohibiting certain individuals from receiving promotional items is strictly against CMS rules.
5. Accepting Enrollment Outside of Scope
Do not accept or process enrollments that fall outside the predetermined Scope of Appointment or that cover plans you are not approved to market.
6. Holding Events Too Close to Competitors or Restricted Areas
Marketing events must be independent and held in a neutral environment. Events cannot overlap with competitors’ presentations or create a conflict of interest.
Tips to Host a Successful Medicare Marketing Event
- Pre-Event Compliance Check: Ensure all promotional materials and presentations are CMS-approved before the event.
- Be Transparent: Clearly communicate the type of event (educational or sales) during event promotions and registration.
- Train Staff: If hosting with a team, provide training on CMS guidelines to ensure everyone knows and follows the rules.
- Create a Welcoming Atmosphere: Use compliant giveaways and refreshments to make attendees feel comfortable and valued.
- Follow Up (Compliantly): For attendees who provide consent, follow up with them after the event to answer further questions or provide enrollment assistance.
Why Compliance Matters
CMS marketing regulations may seem strict, but they are in place to protect Medicare beneficiaries from being misled or coerced. Following these rules demonstrates your integrity and dedication to serving customers ethically. Additionally, compliance protects your business from potential fines, penalties, or loss of Medicare contracts.
Know the Rules, Reap the Rewards
Through hosting a Medicare marketing event, you have a strong means of gaining the trust of beneficiaries and pointing them towards plans that will best suit their needs. When you follow CMS guidelines, your event not only is compliant but also an experience of positive energy and information for attendees.
If you want the next Medicare sales event to be both successful and within the law, then start by reviewing your materials so thoroughly that everybody involved knows exactly what they have to do and how. Many little things add up!
