Rules, Rules, and More RULES!

by Carey Spears, RHU, Spears Insurance, Inc.

for all marketing activities; in person and telephonically, including walk-in, to an agent or broker, and we have to retain the document for ten years, which protects all parties. When this form was first introduced in 2006, it was required to have the individual’s signature 48 hours prior to a meeting. Changes to the rule have allowed beneficiaries to sign when they come to a meeting, but before a conversation begins. The Medicare Scope of Appointment serves as a guideline for your meeting. It’s a form that you and your Medicare insurance agent sign in person or electronically that clearly identifies what specific Medicare insurance products you want to learn more about. If your meeting is over the phone, then your recorded verbal consent may suffice.

Important to know is the insertion in the Scope: By signing this form, you agree to a meeting with a sales agent to discuss the types of products you initialed above. Please note, the person who will discuss the products is either employed or contracted by a Medicare plan. They do not work directly for the Federal Government. This individual may also be paid based on your enrollment in a plan. Signing this form does not obligate you to enroll in a plan, affect your current or future enrollment or enroll you in a Medicare plan.

We will ask our clients to sign an SOA every year. That seems like a lot of duplication but the fact is, under the rules of engagement, we can always talk to you about your current plan and how it changes year to year…but it does not give us permission to tell you that a different plan in the market may offer you lower cost shares or improved benefits and networks. Therefore, a new signed SOA is necessary.

When you review the Scope of Appointment, you will notice that the topics of Life Insurance or Long Term Care are not listed. Those topics cannot be discussed in the same appointment. This is to avoid mixing information of benefits that Medicare does not cover. For instance, if we were to have a mixed conversation, in future years you might recall part of the conversation and in error, believe that all those benefits discussed were included in the plan you enrolled in, only to learn you had confused the information and were operating under false assumptions. Rules are good!

Other rules for the SOA will be when this form can be handed out, such as during educational events. For example, during a seminar on “What is Medicare?” the discussion cannot include specific policies offered by insurance companies, only what and how Medicare works and what you are entitled to. If you want to have a conversation with that presenter regarding Medicare

Advantage Plans or Supplements or Prescription drug plans, then a separate appointment is required. Currently the Scope can be handed out and a signature obtained at the event, or an appointment set. However, CMS is reviewing this rule and, more than likely, going to implement a change that says something like, “No SOA can be obtained at this event, you would need to call the presenter and they would need to mail you the Scope, have it returned and then the appointment can be set.” Sounds like a grand idea, right?

A recent rule implemented just this last October 2022 is the requirement regarding recorded phone conversations. This rule was brought on by the abuse of advertisements offering everything including the kitchen sink.

I warned you before in a previous article about calling Joe and Captain Kirk touting truthful benefits for those who qualify, but if the plan wasn’t in your area, that call center now has you on the line, and maybe said you would get the information you requested, but actually enrolled you in a plan. Yes, sadly, celebrity endorsement has led many people down an inappropriate garden path.

Due to this, all agents and brokers must have a recording phone system to record your phone appointment and all information disclosed during that appointment by you and me, and we must save the recording for 10 years in the cloud! Before our phone conversation can begin, you must hear this required disclaimer:

“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.”

If you don’t want a recorded conversation, then you can come to the office for a Face-to-Face meeting and sign the SOA.

There are reasons why I don’t offer every plan in my area. Typically because the network doesn’t include most doctors or hospitals in the area. Some plans may not even contract with agents at all, forcing you to go through their enrollment center, either by phone or online. The goal of an independent agent is to establish a relationship with you, at no cost to you, in order to weed through the annual changes in plans, with your needs and best interest in mind for years to come.

One last rule: Whether or not I conduct enrollments over the phone, I am required to post the disclaimer below on my website, in electronic communications (in my email signature), and in all advertisements

Well, that’s a wrap for this edition. Your comments are always welcome. Give us a call at 208-265-2026.

“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.”

Carey Spears, RHU is a licensed Life/Health insurance agent with over 27 years experience with Senior products such as Medicare Supplements, Part D Prescription plans and Medicare Advantage Plans. With offices in Sandpoint and Coeur d’Alene, she offers ‘no obligation’ consultations for individuals as well as providing group presentations on the Beginners Guide into Medicare! If you are considering insurance needs, call Carey at 208-265-2026 to learn the right steps in securing your Health Care options.