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The Scope of Appointment (SOA) for Medicare beneficiaries was introduced around 2006. This coincides with the rollout of Medicare Advantage and Medicare Part D plans, which created a new market for insurance agents.

The reason for the SOA stemmed from concerns about some unscrupulous sales practices. There were reports of beneficiaries feeling pressured to enroll in plans during appointments. The SOA helps to ensure transparency and informed decision-making by clearly outlining the purpose of the meeting beforehand.

Key rules pertaining to the SOA: 

• When scheduling an appointment with a potential enrollee, the Scope of Appointment must be documented 48-hours before the appointment. There are a few exceptions to this rule:
  • Enrollment deadline: If the beneficiary is in the last 4 days of their valid enrollment period, the 48-hour rule may be waived.
  • Walk-in appointments: Unscheduled walk-in meetings initiated by the beneficiary are another exception.
• A scope is required for any appointment that Medicare Advantage or Part D Prescription Drug plans are discussed.
• The documentation must be in writing, in the form of a signed agreement by the beneficiary, or a recorded oral agreement.
• The beneficiary must “initial” the box in the form. “Checking” the box is not adequate.
• A Scope is required for each beneficiary. A husband and wife CANNOT sign the same scope.
• A spouse CANNOT sign the scope on behalf of the other spouse unless there is a valid power of attorney in force. Be sure to see a copy of the POA and don’t just take your client’s word that s/he has the legal right to sign.
• Only discuss information agreed to in the Scope of Appointment documentation.
• If a potential enrollee wants information on a product outside of the original scope, a separate meeting must be scheduled at least 48 hours later. This applies to non-health products only (life, LTC, annuities). You can talk about dental, vision & hearing products.
• Scopes are effective for 1 year or 1 enrollment period.
• Agents are required to keep Scopes for 10 (ten) years.

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A permission to contact (PTC) form allows you to talk to clients about Medicare plans. It's important because it follows regulations to protect people from unwanted sales calls.

You need a PTC before you can call, text, social media message, or email someone about Medicare plans. This is true unless they call you first.

Here are some times when you need a PTC:

• Talking to new people about Medicare: You can't just call them out of the blue.
• Following up on questions: If someone asks about Medicare on a website, you need a PTC before calling them

There are a few times when you don't need a PTC:

• Talking to people you already help with Medicare: You can talk to them about new plans.
• Sending mail: You can send letters or brochures to people without a PTC.

PTCs don't last forever. They have a time limit.

• Medicare Advantage and Prescription Drug Plans: PTCs last for 9 months.
• Medicare Supplement Plans: PTCs last for 90 days.

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In today's Medicare landscape, staying informed about the latest updates, regulations, and benefits is crucial for success. To empower you with the knowledge you need to serve your clients effectively, we are excited to introduce our new weekly "Did you know?" email series archived here.

This series will give you a deeper understanding of Medicare, enabling you to confidently guide your clients through their healthcare journey.