Rules for Hosting a Compliant Medicare Educational Event

While events are often a great way to generate leads, holding Medicare educational events during the COVID pandemic is a legal and ethical grey area. What is allowed at seminars for the 2023 Annual Enrollment Period?

Listen to this article:

The Centers for Medicare and Medicaid Services (CMS) have set forth rules on what you can and cannot do when holding Medicare education events.

We’ll cover these guidelines below.

Can Agents Hold Medicare Educational Events During COVID-19?

The COVID-19 pandemic has led to numerous changes in our society: masks, hand sanitizer, social distancing, etc. While more events are being held, we still need to be cautious, especially with clients who have weakened immune systems and pre-existing conditions. Areas may still be restricting gatherings, so are Medicare educational seminars permitted for this AEP?

The answer is: It depends. States and counties are still affected by COVID differently, and therefore, are responding differently. We recommend asking this question to your state’s Department of Insurance, as well as the carriers you represent. The answer will depend on health of your state and counties, whether individuals attending are vaccinated or not, the restrictions of states and counties, and if your carriers are allowing in-person member events at this time. In some cases, you may be able to hold a compliant virtual Medicare educational event, but again, check with your carriers first.

Some retail sales programs may not be offered this AEP or will be offered with additional restrictions. Additionally, some carriers may make the decision to cancel in-person seminars for this AEP. If virtual meetings are not an option, you may have to explore other ways to help your prospective and current clients this AEP. We must all do our part right now to stay safe and protect each other from unnecessary health risks.

Wondering if you need to wear a mask or set out hand sanitizer for appointments? Can you ask your clients COVID-screening questions or check their temperatures before meeting? We answer these questions and more in our post on how to sell Medicare during COVID and AEP .

Establishing Your Event

Have you found out you can still host a Medicare educational event? Then, it’s time to start planning it. Before you get too involved, make sure you review your motivation for putting on the presentation. Affairs like these serve to inform Medicare beneficiaries about Medicare Advantage, Part D, or other Medicare programs. During them, you cannot market specific plans. If marketing is your goal, you must hold and follow CMS’ guidelines for a Medicare sales event. As for the when and where, educational events may be held in a public venue. Under no circumstance should you hold them in in-home or one-on-one settings.

What about a virtual Medicare event? Depending on the carrier and state, you may be able to compliantly hold a virtual education event for Medicare prospects or enrollees during the 2023 AEP. If you are holding a virtual presentation, you will need to choose an online platform (e.g., Skype, Zoom, Facebook Live), instead of a physical location, for your event. Your carriers will likely have specific rules for virtual events, so check with them first.

Looking for affordable ways to host workshops? Check out our budget-friendly T65 seminar tips and ideas

Promoting Medicare Educational Events

You can advertise these events via most forms of marketing, including newspaper and radio ads, flyers, and direct mailers. However, there are a couple guidelines you must follow when marketing educational events:

• All educational events must be explicitly marketed as “educational” to beneficiaries.

• Educational event advertisements and invitations must also contain the following disclaimer: “For accommodations of persons with special needs at meetings call <insert phone and TTY number>.”

When it comes to enrollee-only events, these may qualify as “marketing.” (Typically, enrollee-only events are held for a specific carrier’s current enrollees, and the intent is to retain the current enrollees in a plan.) Since enrollee-only events are conducted on behalf of a specific carrier, we would advise you to follow carriers’ guidelines to stay compliant.

Note: The MCMG has undergone some changes. You can now find the Medicare Advantage and Part D Communication Requirements on the Federal Register site.

Following TPMO Guidelines

CMS now considers agents and brokers to be third-party marketing organizations (TPMOs). Agents and brokers must record all calls (inbound and outbound calls) in their entirety, including calls to inform or educate clients about the event, as well as any post-event discussions. Agents do not need to record conversations when meeting in person.

You can follow these guidelines to stay compliant:

• Disclose to the beneficiary when conducting lead-generating activities that his or her information will be provided to a licensed insurance agent for future contact:
  • Verbally when communicating with a beneficiary at an event
  • In writing when communicating with a beneficiary through mail or other paper communication
  • Electronically when communicating with a beneficiary through email, online chat, or other electronic messaging platform

You must also add the following TPMO disclaimer to your email communications, website, print materials, and other materials for your event.

If marketing fewer than all plans within a service area, use:

“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 (SHIP) to get information on all of your options.”

If marketing all plans within a service area, use:

“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 (SHIP) for help with plan choices.”

Giving Your Presentation

Remember, during educational events, your primary focus is to educate attendees. It is not to lead or attempt to lead attendees toward a specific plan or set of plans.

Follow the guidelines below to help ensure your compliance.

Agents may not conduct sales or marketing presentations or distribute or accept plan applications during an educational event. However, agents may conduct a marketing event immediately after an educational event, even in the same location if they’d like. Attendees must be made aware of the change and given the opportunity to leave prior to the marketing event beginning. Agents can also collect SOAs during the marketing event.

The Importance of Staying Compliant

CMS and carriers take compliance very seriously. We do too.

Keep in mind, carriers may send secret shoppers to your educational events. If you violate Medicare Advantage & Part D Communication Requirements, you could be subject to:

• Administrative hearings
• Administrative penalties
• Cease and desist orders
• License suspension or revocation

Read about the Medicare Advantage and Part D educational event compliance changes coming for 2024

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Medicare beneficiaries need your expertise, and you need their trust and business. While COVID continues to change the Medicare landscape, you will likely be able to hold Medicare educational events in some capacity this AEP — in-person or online. Those events will just look a little differently and so will the rules. As long as you follow them, there’s no reason why you and your clients can’t stay healthy and both benefit this AEP!

Editor’s Note: This article was originally published in May 2017. It has been updated to include information more relevant to the 2023 Annual Enrollment Period.