Leah Kari, Retired Pharmaceutical Representative and Licensed Insurance Agent
Medicare’s marketing rules protect you, the consumer. One of the responsibilities of CMS, Centers for Medicare & Medicaid Services, the federal agency in the U.S. Department of Health and Human Services (HHS), is to administer the Medicare program. CMS annually approves all Medicare Advantage and Prescription Drug Plans in the United States. In addition, CMS protects you, the beneficiary, by regulating the marketing activities of insurance carriers, agents, and brokers (herein called agents) to keep consumers safe from deceptive marketing practices.
Agents must adhere to these regulations governing when and how they may market their plans to you and conduct the enrollment process. Agents are tested annually and must follow the rules or face penalties. The first protection starts with your completing the Scope of Appointment form.
Medicare’s Scope of Appointment form is the cornerstone of your protection. It’s a one-page form that takes a minute to complete. By checking or initialing the topics you’d like to discuss, you avoid bait and switch tactics. You grant permission for the agent to provide cost and benefit information only on the plan types you’ve indicated. Thus, agents are prohibited from presenting products unrelated to health, such as annuities or life insurance.
Do I have to work with this agent or enroll in a plan? No. The form states you have no obligation to work with the agent or enroll in a plan.
How does it work? An agent will ask you to complete the required Scope of Appointment form sent by email, text, or in hard copy form. Completing the form takes under a minute. When you designate the plan types that interest you, this form documents the scope of what may be covered before your actual meeting.
You sign, date the form, and submit it to the agent for completion. Medicare, in most circumstances, requires a 48-hour waiting period, after which the agent may provide benefit or cost information. The period offers you time to review options before meeting with the agent to discuss plan-specific benefit information. When you submit the form, a timer counts down 48 hours before the agent can present plan details.
While waiting, if you grant permission, your agent will compile a list of your providers and prescription drugs to research plans. Don’t dismiss this service, as it can be an integral part of selecting plans to review and saves you countless hours in research.
You are in charge of the discussion. Medicare requires proof that you’ve agreed to meet with an agent to discuss the products indicated on the form. Medicare and insurance carriers audit Scope of Appointment forms and require agent retention for the current year and 10 more years. Agents must produce the signed Scope of Appointment promptly if audited.
Leah Kari, AMR, FHIAS, specializes in showing Medicare eligible people their insurance options. Reach Leah for comments at 520-484-3807 or email [email protected]. (TTY users dial 711.)