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Rules for Agents Who Sell Medicare Plans

Kat Gardner
  • Private Insurance

Medicare insurance has rules that apply to the sales agents that work with Medicare beneficiaries — and that’s a good thing! It helps you know what to expect from a licensed insurance agent that represents Medicare insurance plans. It could even help you recognize potential scam artists.

Today, we’re going to look at what licensed insurance agents can and can’t do so you can be more informed about the assistance your agent is allowed to provide you.

What is a licensed insurance agent allowed to do?

Phone calls

Licensed insurance agents are only allowed to call you if you’ve given permission to be contacted. If you have requested a follow-up phone appointment, they can call you regarding that appointment. Insurance agents are not allowed to cold call you or call you without you contacting them first. Keep reading for more details.

Visiting your home

Licensed insurance sales agents are allowed to visit your home if you invite them to your home. They will not show up on your doorstep without you initiating the meeting. If you miss an in-person meeting, insurance agents are allowed to leave information at your home. But that’s only the case if you missed a set appointment. It can’t be done randomly.

Discussing Medicare insurance plans

Licensed insurance agents are only allowed to discuss the types of Medicare insurance plans you’ve agreed to learn more about during a scheduled appointment. You provide that permission either in writing or through a recorded phone call prior to the sales meeting with the agent. If you want to hear more about other types of plans after you’ve set the initial scope of the appointment, you’ll need to again give your permission.

During Medicare insurance enrollment

A licensed insurance agent is only allowed to request personal information from you when they need that information to verify eligibility for a specific plan or to enroll you into a plan.

If at any other time they ask for personal information such as your Social Security number, Medicare ID number, credit card or banking information, they are in violation of the rules Medicare sets for insurance agents. You should not share any information with that person.

Post-enrollment contact

Insurance agents are allowed to call you after you’ve enrolled in a Medicare insurance plan to discuss other coverage options. However, this is only true if the insurance agent calling you is the same one who enrolled you in the plan. It cannot be someone else from that agent’s company. Your agent can also contact you during the Medicare Annual Enrollment Period from October 15 to December 7 to see if you need to change your coverage in any way.

What is a licensed insurance agent NOT allowed to do?

Phone Calls

Licensed insurance agents who represent Medicare insurance plans are not allowed to cold call you. Agents can only call you if you have a prior relationship with them. If you are receiving calls from an unknown caller claiming to sell Medicare insurance, DO NOT share any personal information. Medicare insurance scams are a popular form of identity theft that targets seniors and other Medicare beneficiaries.

Licensed insurance agents are not allowed to enroll you in Medicare insurance over the phone unless you called them to request enrollment. If you receive a call asking you to enroll in Medicare insurance, it is a scam.

During a Medicare insurance sales call, the agent is not allowed to discuss or sell you non-health related coverage such as life insurance. They must make a separate appointment with you if you request information related to additional products or services. They are not allowed to bring them up in any way during Medicare insurance sales.

Visiting your home

Insurance agents will not visit your home unless you have given them permission to do so. Avoid engaging with anyone who comes to your door claiming to be selling Medicare insurance plans without you making initial contact.

Additionally, licensed insurance agents are not allowed to leave flyers or other advertisements on your door or on your car windshield. However, both regular mail and email communications are allowed.

Discussing plans

During the sales meeting, insurance agents have strict rules they must follow. They’re not allowed to pressure you into enrollment or changing your coverage, and endorsement of any specific plan is not allowed.

Likewise, agents are not allowed to push for sales with cash incentives, free meals or gifts worth more than $15. Medicare could view such incentives as forms of bribery.

During enrollment

Licensed insurance agents are not allowed to enroll you in a Medicare Supplement plan if the agent knows you are enrolled in a Medicare Advantage plan. The only exception to this rule is if your current Medicare Advantage plan coverage will end before the Medicare Supplement plan coverage begins.

After enrolling

Licensed insurance agents should not ask you for referrals. They may leave business cards, but they are not allowed to contact your friends and family without permission from those people. However, if you’re pleased with your agent’s service, you are welcome to share their contact information with people you know.

Conclusion


Understanding what licensed insurance agents that represent Medicare insurance plans can and can’t do is important. It can help you recognize potential fraud and identify theft. It can also help you find quality agents who will follow the rules and treat you with the respect you deserve.

Looking for Medicare insurance guidance you can depend on? We’re here to help. Call us today to set up an appointment with one of our licensed insurance agents.

PlanEnroll is a brand operated by Integrity Marketing Group, LLC and used by its affiliated licensed insurance agencies that are certified to sell Medicare products. PlanEnroll is not endorsed by the Center for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (DHHS), or any other government agency.

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PlanEnroll represents Medicare Advantage HMO, PPO, PFFS, and Prescription Drug Plan organizations that have a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment depends on the plan’s contract renewal. Enrollment in a plan may be limited to certain times of the year unless you qualify for a Special Enrollment Period or you are in your Medicare Initial Enrollment Period. Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply. Every year, Medicare evaluates plans based on a 5-star rating system.

PlanEnroll is a brand operated by Integrity Marketing Group, LLC and is used by its affiliated licensed insurance agencies that are certified to sell Medicare products. PlanEnroll, PlanEnroll.com is a non-government website and is not endorsed by the Centers for Medicare and Medicaid Services (CMS), the Department of Health and Human Services (DHHS) or any other government agency.

We do not offer every plan available in your area. Currently we represent 0-78 organizations which offer 0-2,613 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

The exact carrier and plan counts are determined by your zip code and county.

To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance. If you are already a member, please contact your health plan to file a complaint.

Final expense life insurance may not cover the entire cost of your funeral and may be used by the designated beneficiary for any purpose rather than being limited to specific funeral services and providers. Final expense life policies will have a lower face value than most traditional term or whole life policies as they are intended for a specific purpose of covering those final costs rather than providing comprehensive support for surviving family members. This type of policy generally doesn’t require a medical exam, but premiums will be higher the older you are, and some benefit payouts may be limited during the first few years of coverage for those with significant health issues. Reducing or skipping premium payments will impact the amount of interest paid and may impact how long the policy lasts. Accessing the cash value of a policy will reduce the available cash surrender value and the death benefit. A policy owner does not have the ability to make unlimited payments into the policy. If too much is paid into the policy, it will become a Modified Endowment Contract (MEC) and withdrawals and loans will be taxable. Coverage may not be available in all states and may vary by state. Policy guarantees are based upon the claims-paying ability of the issuing life insurance company.

An annuity is an insurance contract between an insurance company and a contract owner. An annuity can be used to help save for supplemental income for retirement and/or preserve funds already saved for retirement. Interest and other guarantees in an annuity are subject to the claims-paying ability and financial strength of the insurance company that issues the product. Annuities are long-term vehicles. Many have surrender charges over many years, and withdrawals from an annuity prior to age 59 ½ may be subject to a 10% tax penalty. The growth in an annuity is tax-deferred, but taxes will be owed on withdrawals. Any withdrawal will reduce your annuity insurance contract value. Consult your annuity insurance contract for specific terms and conditions. Insurance agents do not provide, tax, legal or accounting advice.

Multi-year guaranteed annuities (MYGAs) are a type of fixed annuity with a guaranteed interest rate that typically lasts for multiple years. Fixed Indexed Annuities (FIAs) do not involve investments in an index. The index performance used to calculate credited interest typically does not include dividends. Some FIAs involve the use of multiple indexes. Methodologies for crediting interest differ among FIA products (e.g., point to point, high water mark, annual resets, single year, multi-year, etc.). Interest crediting methodologies may include caps, participation rates, spreads, margins, or fees that may change from time to time depending on the product.