CMS Rules for Hosting a Compliant Medicare Presentation - Western Asset Protection
hosting a compliant Medicare presentation

CMS Rules for Hosting a Compliant Medicare Presentation

2025 AEP is expected to be a busy time for Medicare agents. For the first time in many years Medicare beneficiaries may see negative plan changes as a result of insurance carriers trying to offset increased costs. This means more enrollees will be shopping around for a new 2025 plan. Many people will be looking for a knowledgeable agent who can help guide them in making the right decision.

To meet the needs of these individuals and tap into this opportunity you need a marketing strategy that gets you out in your community during AEP, building your brand and creating awareness. One tried and true way to do this is by hosting Medicare presentations. Meeting with groups of beneficiaries gets you in front of many people at once and is an effective and efficient use of your time.

There are two distinct types of presentation events, educational events and sales events, and CMS has very specific compliance rules for each one:

Educational Events

An educational event is intended to share general Medicare information without discussing specific plans. These events must be clearly marketed as educational. They do not need to be filed in advance with carriers or CMS.

Compliance Checklist:

Do:

  • Hold your event in a public venue.
  • Hand out generic educational materials on Medicare.
  • Have your generic Business reply cards and business cards available for elective pickup by the attendees – do not pass out.
  • Attendance at an educational event is not considered permission to contact.
  • Answer attendees’ questions but do not provide any additional information beyond what they ask.
  • Provide light refreshments or gifts as long gifts do not exceed $15 per person.
  • Include the disclaimer: “For accommodations of persons with special needs at meetings call <phone number and TTY number>” on all marketing materials.

Do Not:  

  • Distribute or collect Scopes.
  • Discuss specific carrier plans or distribute plan materials.
  • Provide or collect enrollment forms.
  • Discuss any non-Medicare products or services.

Sales Events

Sales events, also known as marketing events, are designed to discuss specific Medicare plans. There are two different types of sales events:

  • Formal Sales Event: a more structured event where an agent presents a carrier specific presentation to invited attendees.
  • Informal Sales Event: a less structured event where an agent offers plan specific information while staffing a table, booth, or kiosk. The agent must be approached for information by the attendee.

For both types of sales events, you will need to register your event with the applicable carriers. Different carriers have different requirements, so make sure you understand the timeline before setting an event date. Most plans require filing 14 days prior to the scheduled event date.

All informational materials must be approved by CMS. All brochures, flyers and advertisements must be compliant and accurately represent the plans you are promoting at your event. Check with your carrier reps as they may be able to provide these materials and save you both time and money. If you are a WAP agent, you can find a listing of the representatives for each carrier in the WAP Health Wealth Engine.

Compliance Checklist 

Do: 

  • Hold the event in a public venue. You may not engage in marketing activities where patients receive health care, such as exam rooms or pharmacy counters. Common areas such as lobbies or cafeterias are acceptable.
  • Name all products and plan types you’ll be discussing up front.
  • Use only carrier and CMS approved presentations and talking points.
  • Use attendee sign-in sheets that clearly indicate providing contact information is optional.
  • Provide light snacks and gifts as long as gifts do not exceed $15 per person.
  • Have your business card and Business reply cards available for elective pick up by attendees.
  • Collect SOA forms at least 48 hours in advance if you plan to meet with a client. The SOA must be specific to the kind of plans you will discuss when you meet.
  • Collect enrollment applications as long as the enrollee has a valid election period.
  • Include the necessary TPMO disclaimer on any marketing materials as well as the disclaimer: “For accommodations of persons with special needs at meetings call <phone number and TTY number>”.

Do Not:

  • Require attendees to provide any contact information in order to RSVP to your event.
  • Compare one carrier plan to another carrier plan by name without getting written consent from all carriers involved. Comparisons must be factually based and can’t be misleading.
  • Request or accept referrals.
  • Discuss or sell any non-Medicare products.
  • Attempt to contact anyone who did not fill out an SOA or permission to contact form.
  • Host a sales event within 12 hours of an educational event in the same building or an adjacent building.

If You Have to Cancel An Event

If you have to cancel an event it’s best to do it at least 48 hours in advance. You should submit notification of the cancellation to the carrier and the venue and notify all attendees. Some carriers may require proof of this. If you need to cancel with less than 48 hours’ notice, it’s required to have a representative on site at the venue for a minimum of 15 minutes to inform attendees the event has been cancelled.

Preplanning is Your Key to Success

Don’t assume that if you host it, they will come. It takes a lot of advertising and follow-up to get people to act.

  • Advertise your event far enough in advance to ensure a good turnout and pre-order any marketing materials you may need.
  • Reserve a suitable space for your presentation. Make sure the location is convenient for you and your attendees. Remember to take into consideration all aspects of the venue including accessibility, parking, room layout, and availability of any technical equipment needed for your presentation.
  • Look for opportunities to co-present with a carrier representative or someone else to maximize your marketing reach and influence.

Questions? The dedicated team at Western Asset Protection is committed to your success. Contact us today.