Rules for Hosting a Compliant Medicare Educational Event

Holding an educational presentation is a fantastic way to grow your client base, but you must make sure to stay compliant.

The Centers for Medicare and Medicaid Services (CMS) have set forth rules on what you can and cannot do when holding Medicare educational events. We’ll cover the ones you need to know as we walk you through how to host a compliant educational event on Medicare.

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Establishing Your Event

If you’re planning on hosting a Medicare educational event, first, 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 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.

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>.”

CMS used to have rules on how agents had to promote and present prospective enrollee educational events and enrollee-only educational events; however, these were absent in their 2019 Medicare Communications and Marketing Guidelines (MCMG). We believe that, based on the 2019 MCMG definitions of marketing and communications, the intent to hold an enrollee-only event 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: CMS has released updates to the MCMG in the form of a memo. Many of the guidelines from the 2019 MCMG, including the ones we just mentioned, are still relevant for 2020.

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.

Educational Event Do’s and Don’ts
Do’s Don’ts
Hand out objective educational materials on MA, Part D, and other Medicare programs Display a sign-in sheet or collect contact info (e.g., names, addresses, phone numbers) of attendees — this doesn’t constitute as permission to contact
Give away promotional items (that aren’t considered marketing materials) that include plan name, logo, toll-free number, and/or carrier website1 Hand out applications or marketing materials which contain specific plan info (e.g., premiums, copayments, etc.)
Answer questions posed by attendees Answer questions beyond what attendees ask
Provide meals, refreshments, or light snacks2 Give away cash or other monetary rebates
Provide generic business reply cards to attendees Provide or collect enrollment forms
Give out your business card and contact info for beneficiaries to use to initiate contact (includes completing and collecting a Scope of Appointment) Discuss any carrier-specific plan or benefits or distribute marketing plan materials
Schedule marketing appointments Give an educational presentation in a one-on-one situation
1,2Items must comply with CMS’ nominal gifts ordinances.

NEW for 2020: According to the changes set forth by CMS in the 2020 MCMG memo, we believe that agents may now conduct a sales event or marketing appointment immediately after an educational event, even in the same location if they’d like. We also interpret this to mean that agents can collect SOAs and take applications after an educational event has concluded.

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 CMS’ Medicare Communications and Marketing Guidelines, you could be subject to:

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

Medicare eligibles and Medicare beneficiaries depend on health insurance agents like you to help them with what can be a confusing and complicated endeavor. They’re vulnerable, and regulations exist to ensure nobody leads them astray. Play it safe and you won’t be sorry.

Editor’s Note: This article was originally published in May 2017. It has been updated to include information more relevant to the 2020 Annual Enrollment Period and the 2020 Medicare Communications and Marketing Guidelines.

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