Medicare Advantage Marketing Rules Have Changed: What Beneficiaries and Caregivers Need to Know

If you've been seeing more Medicare Advantage advertisements lately, there may be a reason.

The Center for Medicare & Medicaid Services (CMS) recently revised several Medicare Advantage marketing rules, giving plans and insurance agents more flexibility in how they market products to Medicare beneficiaries. While many consumer protections remain in place, some restrictions designed to separate education from sales have been relaxed.

For Medicare beneficiaries and caregivers, this makes it even more important to review plan information carefully and compare options before making enrollment decisions.

Why Were the Medicare Advantage Marketing Rules Created?

To understand the recent changes, it helps to know why the previous rules existed in the first place.

Over the past several years, Medicare beneficiaries reported concerns about confusing advertisements, aggressive sales tactics, and situations where they felt pressured into discussing or enrolling in plans that they didn't fully understand. Policymakers were particularly concerned about television ads, marketing calls, and sales presentations that sometimes blurred the lines between education and sales. CMS responded by implementing additional consumer protections between 2023 and 2025.

The earlier rules were designed to:

• Create a clearer separation between educational events and sales events.

• Give beneficiaries time to think before meeting with an insurance agent.

• Reduce pressure to make immediate decisions.

• Ensure marketing claims could be supported with evidence.

• Increase oversight of agents, brokers, and third-party marketing organizations (TPMOs).

CMS reported that it rejected more than 1,500 television ads between 2023 and 2024 because they were found to be non-compliant or misleading.

What Has Changed?

Under the updated rules, insurance agents and plans may now:

• Hold marketing presentations immediately after educational events in the same location, provided attendees are informed and have the opportunity to leave before the sales presentation begins.

• Schedule personal marketing appointments as soon as a Scope of Appointment form is completed.

• Collect Scope of Appointment forms during educational events.

• Use marketing terms such as "best," "top," and "most" without submitting supporting documentation in advance, although CMS may still request supporting evidence.

These changes are intended to reduce administrative requirements for insurers and agents, but some consumer advocates worry they could make it more difficult for beneficiaries to distinguish between educational information and sales presentations.

What is a Scope of Appointment Form?

I personally, a caregiver myself, have never heard of a Scope of Appointment (SOA) form, so I had to Google it and find out.

A Scope of Appointment form is a document Medicare requires insurance agents to obtain before discussing specific Medicare Advantage or Part D prescription drug plans with a beneficiary. The form identifies which products the beneficiary wants to discuss and help protect consumers from being pressured into conversations they didn't ask about.

It's basically a permission slip to the insurance agent that says:

"Yes, I would like to speak with you about Medicare Advantage plans, Medicare Part D prescription drug plans or both."

For example, if your mom attends a Medicare seminar and wants information about Medicare Part D, and agent would ask her to fill out a Scope of Appointment form before discussing specific plans.

Under the updated rules, agents can now collect these forms during educational events and quickly move into one-on-one sales discussions.

Signing a Scope of Appointment form DOES NOT enroll someone in a plan and DOES NOT require them to make a decision that day.

What Hasn't Changed?

Even with these revisions, important consumer protections still remain in place.

Insurance agents and marketing organizations are still required to provide disclosures, plans must continue to follow Medicare marketing standards, and misleading or deceptive advertising remains prohibited.

Beneficiaries still have the right to:

• Ask questions.

• Take information home.

• Compare plans.

• Consult family members.

• Delay making a decision until they feel comfortable with their choice.

Why This Matters During Medicare Advantage Open Enrollment

Every fall, Medicare beneficiaries receive an Annual Notice of Change (ANOC) from their current health plan.

This document explains any changes that will take effect next year, including:

• Monthly premiums

• Deductibles and copayments

• Prescription drug coverage

• Provider networks

• Supplemental benefits

• Prior authorization requirements

Many people assume that if they are happy with their current plan, they do not need to review their ANOC. Unfortunately, significant plan changes can occur from one year to the next.

With Medicare Open Enrollment running from October 15 through December 7, beneficiaries have the opportunity to compare plans and make changes for the upcoming year.

The increased marketing activity that may result from these rule changes makes it especially important not to rely solely on television ads, mailings, educational presentations, or sales pitches when choosing coverage.

It's OK to Slow Down

If you're helping a parent, spouse, or loved one navigate Medicare, remember that an educational seminar may now be followed immediately by a sales presentation.

There is no requirement to make a decision during the meeting.

Take the information home.

Tips for Beneficiaries and Caregivers

Before enrolling in a new Medicare Advantage Plan:

• Read the ANOC carefully.

• Compare your current plan with other available options.

• Verify that your doctors, specialists, hospitals, and pharmacies participate in-network.

• Review prescription drug coverage to ensure your medications remain covered.

• Ask questions about prior authorization requirements.

• Use Medicare.gov or call 1-800-MEDICARE for unbiased information.

• DO NOT feel pressured to enroll during a meeting or presentation.

  
  

The Bottom Line

The Medicare Advantage marketing rules have changed, allowing insurance agents and plans greater flexibility in how they discuss coverage options with beneficiaries. Some of the guardrails were introduced to separate education from sales and to slow the enrollment process have been relaxed. This means that beneficiaries need to be informed shoppers.

As Open Enrollment approaches, one of the best things you can do is review your Annual Notice of Change, compare your options, and take the time to make an informed decision. The plan that worked well this year may not be the best fit next year.

The best Medicare decision is not the one with the most advertising. It's the one that best meets your healthcare needs, prescription drug requirements, provider preferences and budget.

For more information:

• CY 2027 Changes to the Medicare Advantage Organization and Medicare Drug Plan Sponsors Marketing Regulations

• Changes to the Medicare Advantage Organization and Medicare Drug Plan Sponsors Marketing Guidelines

• How CMS Policies to Reverse Protections for Medicare Beneficiaries Reflect a Broader Deregulatory Push

• CMS Rolls Back Medicare Advantage Marketing Rules

• Medicare's Marketing Guardrails Loosen October 1 - Just Before Open Enrollment