2018 CMS Marketing Guidelines Changes

The following are a few highlights of the recently released 2018 CMS Medicare Marketing Guidelines. The full guidelines can be found on the CMS website here.

70.4.1 – Educational and Marketing Events

42 CFR 422.2268, 423.2268, 422.504(f)(2), 423.505(f)(2)

Plans/Part D Sponsors are not required to upload educational, formal and/or informal marketing/sales events in HPMS. Plans/Part D Sponsors must keep accurate records of all marketing/sales and educational events, and CMS reserves the right to request event information at any time.


Agents may still be required to provide carriers with information about events they are participating in and should keep their own records in the event of a CMS audit but carriers will not be required to proactively provide this information to CMS. CMS not requiring event data to be submitted could mean a reduction in CMS secret shopper activity at these events. However, maintaining compliance with all regulations at these events should remain a top priority.


100.7 – Third-Party Websites

A third-party website is defined as a site that is not owned by a Plan/Part D Sponsor, but a by company with whom the Plan/Part D Sponsor has a contract for the purpose of selling or promoting its products.

Website owners should contact the Plans/Part D Sponsors with which they contract to discuss the website submission process. When a website owner is contracted with multiple Plans/Part D Sponsors, we suggest they coordinate the Multi-plan submission process for the website. See section 90.2.3. Plans/Part D Sponsors are not required to submit third-party marketing websites to HPMS that do not include any plan-specific information. Plans/Part D Sponsors must ensure that third-party websites with which the Plan/Part D Sponsor contracts does not:

  • Provide misleading information, such as identifying a Medicare Supplement plan as a Medicare Advantage plan; or
  • Use prohibited terminology, including unsubstantiated absolute superlatives.

Third-party websites may request, but not require, health status information.


As an agent if you have a public website with plan-specific information you must comply with CMS regulations and are required to submit it to through your carrier partner for approval by CMS.


120.4.1 – General Rules Regarding Compensation

42 CFR 422.2272(c)-(e), 422.2274(c) and (d), 423.2272(c)-(e), 423.2274(c) and (d)

Plans/Part D Sponsors may not pay agents/brokers who have not been trained and tested.


This statement further clarifying agents/brokers cannot be paid if they have not been trained and tested was added.


 70.4.3 – Scope of Appointment

42 CFR 422.2262, 422.2268(g) and (h), 423.2262, 423.2268 (g) and (h)

When conducting marketing activities, in-person or telephonically, a Plan/Part D Sponsor may not market any health care related product during a marketing appointment beyond the scope that the beneficiary agreed to before the meeting. The Plan/Part D Sponsor must document the scope of the appointment prior to the appointment. Distinct lines of plan business include MA, PDP and Cost Plan products. If a Plan/Part D Sponsor would like to discuss additional products during the appointment in which the beneficiary indicated interest, but did not agree to discuss in advance, the Plan/Part D Sponsor must document a second scope of appointment (SOA) for the additional product type to continue the appointment.


The following reference to 48 hours and when practical was removed: “The Plan/Part D Sponsor must document the scope of the appointment 48 hours prior to the appointment, when practicable.” This seems to acknowledge the vagueness of the “when practical” requirement and indicates the SOA can be obtained at any time prior to the appointment.


This summary is not intended to be a complete representation or interpretation of changes in the 2018 CMS Medicare Marketing Guidelines. The complete guidelines can be viewed on the CMS website here.