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If you market Medicare products, you must follow CMS guidelines in your daily Medicare activities. It’s important you know these regulations and understand how they govern your business and conduct. The guidelines apply to all Medicare age-ins and existing beneficiaries. When in doubt – ask questions!

Download the full CMS Medicare Communications and Marketing Guidelines (MCMG)

2020 Sales Kits & 2020 Star Rating Information
  • CMS released new Star Ratings in mid-October; they allow 21 days for replacements
  • You’re out of compliance if old rating sheets haven’t been replaced with the new 2020 Star Ratings in 2020 Enrollment Kits you have in your possession; always check your kits
  • Be sure to destroy any 2019 Enrollment Kits or sales materials specific to 2019 plans; recycling is encouraged
Unsolicited Direct Contact / Consent-to-Contact & SOA Forms
You’re not permitted to market through unsolicited direct contact, referred to as “cold calling” – this includes going door-to-door.
  • Consent-to-Contact must be obtained before contacting beneficiaries by phone
  • Be sure to secure and document an SOA prior to meeting with potential enrollees when an individual or personal one-on-one appointment falls outside of a formal or informal marketing/sales event
  • SOA documentation can be:
    • Beneficiary signed, hard copy
    • Telephonic recording
    • Electronically signed
  • Check with carriers for their process
  • Consent-to-Contact and SOA forms must be maintained by either you or the carrier for at least 10 years per CMS guidelines
  • Contacting Medicare Beneficiaries can be found on CareFree’s agent website under the Marketing Resources tile; it explains what CMS will and will not permit when contacting beneficiaries  

Member Complaints 
To avoid receiving member complaints, prior to enrollment be sure to:

  • Explain thoroughly the plan type being sold and how care will be received (e.g. if a client switches from having Original Medicare with a PDP to an MAPD, they’ll now use a physician network; copays could be different)
  • Do a comparison and benefit analysis so your client knows the differences between their old plan vs. the new plan (i.e. benefits, physician network, copays, cost sharing)
  • Always confirm the client’s physicians and specialists are in network and their medications are on the formulary
  • Be clear when explaining any included dental benefit (some plans may require a provider network, some may offer a reimbursement benefit where member pays out-of-pocket for services, then requests reimbursement, etc.)

Thank you for being CareFree. If you need assistance, contact the Compliance Team via email: carefreecompliance@carefreeinsurance.net.

Your CareFree Compliance Team

CareFree Insurance Services
888-549-4800
Monday - Friday, 8:30 AM - 5:00 PM ET

agentservices@carefreeinsurance.net

 

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