What Rules Must Medicare Agents and Brokers Follow?
Short answer
Agents and brokers marketing Medicare Advantage and Part D products must comply with CMS requirements and applicable state licensing rules, including rules against misleading representations and prohibited sales practices.
Coverage And Action
Consumers should understand which organization an agent represents, which products are being discussed and that Medicare plan enrollment is voluntary. Preserve recordings, messages and enrollment documents if misconduct is suspected.
Not Automatic
An agent’s license does not mean the agent represents every carrier or can guarantee provider participation, formulary status or future benefits. Those facts require current plan verification.
Practical Example
A licensed broker can compare authorized products but should not claim to be calling from Medicare or promise that a physician will remain in-network indefinitely.
Questions to verify
- Is the agent licensed and authorized?
- Which plans or carriers are represented?
- Were any guarantees made that should be verified?