Medicare Part D Insurance Agent Rules

Medicare PDP Agent

Medicare Part D Agent Rules

If you’re enrolled in Original Medicare (which is Medicare Part A and Part B), the benefits that are offered are basically the same for you and all of the other enrollees. These standardized Medicare coverage options actually come direct from Medicare itself, so if you want to learn more about copayments, coinsurance, deductibles, and / or premium costs, you can oftentimes find exactly what it is you’re looking for directly on Medicare’s official website. (This site can be accessed by visiting

But if you also are enrolled in a stand-alone Medicare Part D prescription drug plan, things can be a bit different. There are some good reasons for this. First off, these plans are not provided directly by Medicare, but rather they are sold via private insurance carriers that have been approved by Medicare to do so.

Because of that, Medicare Part D drug plans can differ – sometimes substantially – from one plan to another, and from one insurance carrier to another. These differences don’t just pertain to the benefits that are provided but also with the premiums that are charged.

With that in mind, unlike with Medicare Parts A and B, there isn’t just one central website or portal where you can go to get an overview of Medicare Part D prescription drug plan premiums, benefits, and other key information.

What Medicare Part D Agents and Brokers Can and Cannot Do When Marketing Plans

Based on the updated Medicare Communications and Marketing Guidelines that were published in July 2018, Medicare Part D plan agents and brokers are allowed to conduct the following activities as they pertain to marketing Medicare prescription drug plans over the phone:

  • Call current plan enrollees – including those who are enrolled in non-Medicare products – in order to discuss plan related business. Some examples of this include making calls to enrollees who are “aging-in” to Medicare from commercial products that are offered via the same organization, making calls to an organization’s existing Medicaid / MMP plan enrollees to talk about its Medicare products, and making calls to current Medicare Advantage enrollees in order to promote other Medicare plan types or to discuss plan benefits.
  • Call plan beneficiaries who submit enrollment applications in order to conduct business that is related to enrollment.
  • Call former enrollees after the disenrollment effective date in order to conduct disenrollment surveys for quality improvement purposes. It is important to note here that disenrollment surveys – including those that are conducted by the telephone, email, or conventional mail – are not allowed to include sales or marketing information. Likewise, it is also important to be mindful of the fact that agents and brokers are not allowed to conduct this type of activity.
  • Under limited circumstances and with approval from the Centers for Medicare and Medicaid Services (CMS) account manager, call LIS-eligible enrollees that a plan is prospectively losing due to reassignment in order to encourage them to remain enrolled in their current plan.
  • Call individuals who have given permission for a plan or a sales agent to contact them. Some examples of giving “permission” may include filling out a business reply card, emailing the Medicare Part D sponsor and requesting a return phone call, and / or asking a customer service representative to have an agent contact them. Here, permission applies only to the entity from which the individual requested contact and for the duration and topic of that particular transaction.
  • Return phone calls or messages from individuals or enrollees, as these are not considered to be unsolicited contacts.

According to the new Medicare Communication Guidelines, it is also permissible for Medicare Part D sponsors to make unsolicited direct contact with potential enrollees via the following methods:

  • Conventional Mail and other print media, such as direct mail and advertisements, and / or
  • Email – provided that all such emails also contain a way for the recipient to opt out of these communications.

So, even if you aren’t in the market for a different Medicare Part D prescription drug plan, you may still be contacted about this type of coverage over the phone, via email, and / or by regular mail.

That being said, Medicare Part D agents and brokers may also offer nominal gifts to prospects and enrollees – again, provided that these gifts fall within the Medicare Communications guidelines.
For instance, the following rules apply to Medicare Part D marketing-related gifts:

  • The value of the gift that is given must be $15 or less
  • Such gifts may not be in the form of cash and / or other monetary rebates – even if the value of the gift is $15 or less
  • The gift must be given to the prospective enrollee, regardless of whether or not he or she actually signs up for the Medicare plan
  • If the gift is actually a chance to receive one large gift or a communal experience – such as attendance at a concert or for a drawing – the total fair market value must not exceed the nominal per person value, based on anticipated attendance. As an example, if ten people are expected to attend an event, the nominal gift must not be worth more than $150 (i.e., $15 for each of the ten anticipated attendees). In addition, the anticipated attendance must be based on the size of the venue, the response rate, and / or the advertisement circulation.

On a related note, Medicare Part D plan sponsors are not allowed to either provide or subsidize meals at sales or marketing events. However, refreshments and light snacks may be provided to the attendees at these events.
In this case, it is important that the Medicare Part D plan sponsor ensure that the food items that are being provided at the event not be reasonably considered a meal, and that multiple items are not being “bundled” and offered as if they were in fact a meal.4

Do You Need More Information About Medicare Part D Prescription Drug Coverage?

If you’re in the market to purchase a Medicare Part D prescription drug plan for the first time, or if you are interested in making a prescription drug plan change, it can be beneficial for you to discuss your needs with a professional who specializes in this type of coverage. That way, you can ensure that you get all of your questions answered before making a long-term commitment to this change in your coverage.

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Author Bio: Ben started Prepare for Medicare in 2014 to help people help people get objective answers to questions about Medicare. He’s held leadership roles at numerous Fortune 500 Medicare health insurers in product development, sales, marketing and strategy for over 20 years.