The Importance of Compliance and Ethics in Medicare Insurance Sales

Consumers need to be protected, especially those in vulnerable populations such as those with disabilities or who are at an advanced age. Licensed insurance agents conduct ethical Medicare insurance sales to prevent fraud, waste, and abuse, stay in line with CMS guidelines, and care for their communities. Complying with all applicable federal and state regulations is how you keep your agency in business and remain a reputable Medicare insurance agent for years.

Federally Regulated Services

The established guidelines of the Centers for Medicare & Medicaid Services regulate Medicare insurance sales. Licensed agents provide educational plan materials and information resources, discuss the plans the client expresses interest in, and provide enrollment forms if requested. So, why is it important?

Prevent Waste and Harm

America’s seniors and those with disabilities are eligible for Medicare benefits and can enroll themselves in Medicare without assistance. Licensed agents who sell Medicare products do not receive any pay directly from the Medicare beneficiary—agents get paid a set compensation fee for the first year of a new policy and a lower fee for renewals. The clients go to their local agents expecting advice and expertise on the policies available in the area, so acting in their best interests for coverage and costs is the agent’s role. 

Unethical sales practices, including but not exclusive to selling beyond the scope of appointment, discussing unrelated insurance products, enrolling clients without their consent, using unapproved plan terminology (“best”), persuading a client to enroll in a specific plan, contacting clients without permission, visiting a client’s home without permission, asking for personal information or banking information, and offering gifts are easy ways to get terminated by an agency or insurance carrier.

Protect Your Business

Medicare clients choose to work with licensed agents they trust and who they believe have their best interests at heart. Building those client relationships comes from establishing credibility for yourself as an agent and for your business. The reputation of both can be irreparably damaged if you act unethically or non-compliant in your Medicare insurance sales.

Clients who feel wronged by an insurance agency’s conduct or malpractice should report the business directly to Medicare at 1-800-MEDICARE or the Centers for Medicare & Medicaid Services. 

Compliance Training

During the coursework for AHIP certification, licensed insurance agents go through Medicare fraud, waste, and abuse (FWA) training. This helps agents understand how to identify FWA, the efforts of the industry to detect fraud, legal tools they can use to combat FWA, the human and financial costs of FWA, who commits FWA, reporting FWA, loopholes and obligations, and general compliance requirements for Medicare Advantage and Medicare Part D.

Agents can view the Medicare Communications and Marketing Guidelines on the CMS website. Contact the Magellan Healthcare team for more resources, guidance, and agent support or to learn how to become a partner.