Marketing Medicare Advantage and Part D Plans: CMS Rules and SOA

The CMS marketing rules for Medicare Advantage and Part D plans sit in 42 C.F.R. Part 422, Subpart V and the parallel Part 423 provisions, and they govern almost every touchpoint an agent or plan has with a beneficiary: what counts as marketing, when you can start each year, how you can make contact, what you have to say, what you cannot give away, where you cannot stand, and what you have to record and keep. Break one of them and you can lose your ability to sell Medicare products.

What Counts as Marketing

Everything you send or say to a current or prospective enrollee is either a communication or marketing. Communications is the broader bucket: any material or activity that provides information without trying to steer a plan choice.¹ A member notice explaining how to use the pharmacy network is a communication.

Material becomes marketing when it meets both an intent test and a content test. The intent has to be to draw attention to a plan, influence an enrollment decision, or encourage someone to stay enrolled. The content has to touch benefits, premiums, cost-sharing, Star Ratings, plan comparisons, or rewards and incentives.² CMS looks at objective factors like audience, timing, and context, not just what the plan says it meant. Marketing material carries a heavier review load and triggers most of the rules below.

When You Can Market Each Year

CMS controls the calendar. Marketing for the upcoming contract year can begin on October 1. Enrollment applications for that year cannot be accepted until the Annual Enrollment Period opens on October 15 and runs through December 7. Before October 1, a quiet period bars any marketing for the coming plan year, so every plan releases new-year information on the same day.³ Current-year content must stay on plan websites through December 31.

The Medicare Advantage Open Enrollment Period runs January 1 through March 31, and the rules get tighter. Organizations cannot knowingly target or send unsolicited marketing to any MA enrollee during the OEP. Agents cannot call former enrollees who chose a new plan during AEP, cannot buy mailing lists to find OEP-eligible beneficiaries, and cannot promote the OEP as a sales opportunity. If a beneficiary reaches out on their own, the plan can respond, schedule a one-on-one, or provide information through its call center, but the contact has to be beneficiary-initiated.⁴

Contact Methods That Are Banned

Several outreach methods are prohibited year-round, regardless of enrollment period. Unsolicited door-to-door solicitation is out, and that includes approaching a long-term care facility resident who did not ask for a visit.⁵ Cold calling is banned. Unsolicited text messages, voicemails, and other electronic messaging fall under the same prohibition. Every contact has to either be initiated by the beneficiary or come through a pre-approved channel.

Gifts, Incentives, and Cross-Selling

Cash and monetary rebates cannot be used as enrollment incentives. Any gift to a potential enrollee has to be of nominal value, meaning no more than $15 per item and $75 in aggregate per person per year, and it has to be available to everyone regardless of whether they enroll. Cash gifts of any amount are prohibited.⁶ Cross-selling non-healthcare products during any Medicare sales activity or presentation is also banned.

Educational Events Versus Sales Events

CMS draws a hard line between educational events and marketing or sales events, and agents who blur it invite enforcement action. The rules for each sit in 42 C.F.R. § 422.2264(c).

Educational Events

Educational events give general information about the Medicare program without promoting a specific plan, and they have to be advertised as educational. At these sessions, agents can distribute general communications materials, hand out business cards, and make business reply cards available. They can answer questions about specific plans only if a beneficiary asks first.⁵ What agents cannot do at these events is conduct sales presentations, distribute plan-specific marketing materials, accept enrollment applications, or distribute or collect Scope of Appointment forms.

Marketing and Sales Events

Marketing events are built to discuss specific plan benefits and accept enrollment. Agents can present plan details, distribute marketing materials, collect Scope of Appointment forms for future appointments, and accept enrollment forms on the spot.⁵ The restrictions are just as important:

No mandatory sign-ins. Attendees cannot be required to provide contact information or sign in to enter.
No health screenings, surveys, or similar activities that could be used to identify healthier beneficiaries.
No meals. Light refreshments and snacks are allowed, but meals cannot be provided or subsidized at any event where plan benefits are discussed or materials are handed out.
No marketing event within 12 hours of an educational event in the same building or adjacent buildings.

Drawing information collected for a raffle cannot be used for any purpose beyond the raffle itself.⁵

Scope of Appointment and the 48-Hour Rule

Before any one-on-one or small-group marketing appointment, the agent has to obtain a completed Scope of Appointment form documenting exactly which product types the beneficiary agreed to discuss. The form has to be completed at least 48 hours before the meeting.⁷ The waiting period exists to head off high-pressure same-day sales.

The SOA lists specific product categories: Medicare Advantage, Prescription Drug Plans, Medicare Supplement. Agents cannot discuss any product not on the form. If the beneficiary wants to explore something else mid-meeting, a new SOA has to be signed first.

Two situations exempt agents from the 48-hour wait. First, walk-ins: if a beneficiary shows up unscheduled at an agent’s office, a kiosk, or a plan office, the SOA is still required but the waiting period is not. Second, the last four days of a valid election period: an SOA completed on or after December 3, for example, can lead to an appointment before the AEP closes on December 7.

Organizations have to retain SOA documentation and other sales and enrollment records for ten years.⁸

The TPMO Disclaimer and Language Rules

Any third-party marketing organization selling plans on behalf of more than one MA organization has to deliver a standardized disclaimer. If the TPMO does not represent every plan available in the beneficiary’s area, the disclaimer reads: “We do not offer every plan available in your area. Currently we represent [number] organizations which offer [number] products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.”⁹ A slightly different version applies when the TPMO does sell for every organization in the service area.

Timing and placement are strict. On a sales call, the disclaimer has to be delivered verbally within the first minute. In email, online chat, or other electronic communication, it has to appear at the outset. It has to be prominently displayed on TPMO websites and included in print materials and television advertisements.

Required materials also have to be translated into any non-English language spoken as the primary language by at least 5 percent of individuals in the plan’s service area.⁹ A standardized notice of language assistance services, telling enrollees that free interpreter services are available, has to appear in at least 15 languages, including Spanish, Chinese, Tagalog, French, Vietnamese, Korean, Russian, and Arabic. Additional languages are added when a service area hits the 5 percent threshold.

Where You Cannot Market Inside Healthcare Settings

Location matters. Marketing activities and materials are prohibited anywhere care is actively being delivered:

Exam rooms
Hospital patient rooms
Treatment areas where patients interact with clinical staff, including dialysis facilities
Pharmacy counter areas

Common areas inside healthcare facilities such as waiting rooms, entryways, and vestibules are permitted.¹⁰ A brochure rack in the lobby is fine. Handing out enrollment forms next to the pharmacy counter is not.

When a provider acts on behalf of an MA organization during plan-initiated activities, the provider also cannot distribute marketing materials or enrollment forms in areas where care is delivered.³ Provider-initiated activities done at the patient’s request as part of the clinical relationship, like sharing printed material from Medicare Plan Finder, fall outside the definition of marketing entirely.

Call Recording and Retention

MA organizations have to ensure that TPMOs record all marketing, sales, and enrollment calls in their entirety, including the audio portion of calls conducted through web-based technology.¹¹ “In their entirety” means the full call from start to finish, no gaps or selective recording. The requirement applies to TPMO arrangements beginning with contract year 2025.

Recorded calls related to the sales or enrollment process have to be kept for ten years. Calls that never touch sales, like a beneficiary calling only to schedule an appointment or request a replacement ID card, do not carry the retention obligation. But if a routine call turns into sales at any point, the whole recording has to be kept.⁸

Annual Agent Training and Testing

Every agent and broker who sells Medicare Advantage or Part D has to complete annual training and testing on Medicare rules, regulations, and plan-specific benefits before marketing or enrolling beneficiaries for a new contract year. It is not one-and-done. Organizations and the TPMOs working on their behalf have to verify that all agents, whether directly employed, subcontracted, or operating through a downstream entity, complete the training and testing each year.¹²

Training covers communication and marketing requirements, enrollment and disenrollment processes, and the specific benefits of every plan the agent intends to sell. An agent who does not finish the cycle on time cannot legally market or sell until they do. This is one of the most common compliance stumbles for newer agents, and plan sponsors take it seriously because CMS holds the sponsor accountable for its agents’ behavior.

How Violations Get Reported

Beneficiaries who experience aggressive sales tactics, misleading information, or other marketing violations can call 1-800-MEDICARE (1-800-633-4227) around the clock or file a complaint online through Medicare.gov.¹³ TTY users reach the same service at 1-877-486-2048. State Health Insurance Assistance Programs also help beneficiaries identify and report suspected marketing fraud, errors, and abuse, and SHIP counselors can refer cases to CMS. Patterns of complaints against a plan or agent can trigger audits and enforcement, so every beneficiary interaction leaves a trail CMS can follow.