Making sense of CMS's 48 hour rule

CMS revived the 48-hour rule for 2024, and the 2025 final rule doesn’t mention it at all. That means it’s likely here to stay. But fear not, we’ve got a few tips on how to turn it into a secret weapon.

The rule, in a nutshell

Simply put, you must get a signed Scope of Appointment at least 48 hours before your appointment. And, that is a literal 48 hours. If you collect a signed Scope at noon on Tuesday, you can’t have an appointment any earlier than noon on Thursday.

The intent, according to CMS, is that the cooling-off period gives beneficiaries time to talk to caregivers and decide whether they really want to meet with an agent.

Now what?

Once you’ve collected the Scope of Appointment, it’s good for a whole year, or until you put it to use. More on that in a bit.

You must also store the signed Scope for the remainder of the current year, plus 10 years. If you’re not a paper person, agents aligned with Action can save time and filing cabinet space with their no-cost access to CoverageForOne®, powered by SunFire®. See how in under five minutes>

But wait, are there any shortcuts?

You will always need a Scope of Appointment to present any Medicare Advantage plan or Prescription Drug Plan to a prospect or client. But here’s the lowdown on two exceptions to the 48-hour waiting game:

• The 48-hour rule does not apply when a beneficiary is in the last four days of any valid enrollment period, including AEP, MA-OEP, Initial Coverage Election period, and/or Special Election Periods.
  
  
• The second exception is for unscheduled walk-in or call-in meetings – so long as the appointment is initiated by the beneficiary.

Ok, but how do I make it work for me?

In today’s fast-paced world, waiting 48 hours can feel like a lifetime. Some consumers may be annoyed by what they might see as an unnecessary barrier to getting health coverage. But, this is an excellent opportunity to build trust through transparency.

Telling – and showing – clients that you are committed to following every CMS rule can help ease any concerns they might have about working with an agent, especially if this is their first dabble with Medicare. And, this is fairly cheap marketing content, too – consider a blog post, announcement, or newsletter educating your clients about SOAs and the rules surrounding them. Demonstrating your savviness before they even talk to you is a surefire way to stay top-of-mind when they shop for insurance.

Remember we talked about those Scopes being good for 12 months? There’s a nifty way to use that to your advantage, too -- building trust through efficiency. Have your clients complete a new Scope of Appointment after each time you meet with them. That way, you’ll be able to start the next AEP with a bang – not with a whimper as you wait for the 48-hour rule to expire.

Embrace the change

We get it. The comeback of the 48-hour rule wasn’t everyone’s cup of tea.

Trust us, we heard you loud and clear at our AEP kickoff. But, CoverageForOne makes the collection of Scopes a cinch. And, there are some ways to use the rule in building your credibility as a trusted expert.