Nine things Medicare agents must say at every formal marketing event

You’ve scheduled an event at your local senior center. You’ve filed your formal marketing event with the carrier and CMS. The presentation is all queued up. And you’ve done the math – your pizzas and giveaways add up to less than $15 per attendee. You’re in the clear, right?

Not so fast.

Recently, CMS and our carrier partners have secret-shopped several formal marketing events. And, well, they’ve found that sometimes, agents aren’t sticking to the approved scripts.

While the carrier’s script should have everything you need to put a smile on a secret shopper’s face, there might be a few things you’ll be tempted to gloss over – since you’d never forget them, of course. Here are the nine things most commonly left out of formal marketing events, so you can brush up before your next go around.

1. Will Medicare Advantage enrollees still need to pay a Part B premium?

This item made the top of the CMS and carrier hotlist. At every formal marketing event, and indeed in every sales and enrollment meeting you have, make it clear that enrollees will still be responsible for their monthly Part B premium. In 2025 the base premium is $185.00, but may be adjusted based on the beneficiary’s income and tax filing status. 

2. What are Medicare Late Enrollment Penalties?

Carriers also found agents were glossing over Late Enrollment Penalties. It’s key to inform beneficiaries of the three penalties they may be subject to if they don’t enroll in the appropriate parts of Medicare when they are first eligible.

• Beneficiaries not entitled to premium-free Part A will pay an extra 10% for twice the number of years they did not sign up
• Beneficiaries may be subject to a lifetime 10% Part B Late Enrollment Penalty if they miss the appropriate enrollment windows
• Beneficiaries may face a Part D Late Enrollment Penalty if they miss their initial enrollment, or lack creditable coverage for a given period. The penalty is 1% of the national base premium multiplied by the number of months beneficiaries failed to enroll when eligible.

3. What is a prescription drug formulary?

Agents sometimes neglect to explain drug formularies and their impact on drug coverage and pricing. Beneficiaries should leave each session knowing that each Part D sponsor arranges all the prescriptions it will cover onto a tier list or formulary. Drugs at lower tiers, like Tier 1, will typically be generic drugs and the least expensive drugs on the list. Drugs at higher tiers, like Tier 5, will typically be more costly specialty drugs that may require more out-of-pocket costs for the beneficiary.

4. What is step therapy?

Medicare enrollees should know that their prescription coverage, whether via a Medicare Advantage Plan or a stand-alone Prescription Drug Plan, will likely include step therapy. Step therapy requires doctors and patients to try less-costly, lower-tier drugs to treat conditions before more expensive ones are used. This measure helps save money for patients and insurers alike.

5. What is the Low-Income Subsidy (Extra Help)?

CMS and carriers want beneficiaries to know they may be eligible for help paying their Medicare Part D premiums and out-of-pocket costs. The Low-Income Subsidy (LIS) or Extra Help program is designed to do just that. Beneficiaries who meet the income and resource limit requirements will pay no premium or deductible. In 2025, they’ll also pay no more than $4.90 for generic prescriptions or $12.15 for brand-name prescriptions.

6. What are the Medicare enrollment and disenrollment periods?

Beneficiaries should leave each formal marketing event knowing when they may enroll and disenroll in the various parts of Medicare. Be prepared to discuss the seven-month Initial Enrollment Period, General Enrollment Period, and common Special Enrollment Period opportunities. You’ll also want to make sure beneficiaries know about the Medicare Open Enrollment Period (or Annual Election Period if you’ve been at this awhile) and Medicare Advantage Open Enrollment Periods. 

7. What are Medicare Plan Star Ratings for the plan(s)?

CMS’s Star Ratings program helps beneficiaries compare plans on the quality of care and customer satisfaction they provide. Unfortunately, it seems that some agents fail to communicate the program’s existence and intention during formal marketing events. Be sure beneficiaries know every plan is rated from one to five on a variety of criteria. And, that the more stars a plan earns, the better it performs in CMS’s eyes. 

8. Are preventive benefits covered at no cost?

It’s really easy to get wrapped up in the supplemental benefits a Medicare Advantage plan may provide. But, to stay compliant, you’ll also need to spend some time discussing the core health coverage included in the plan – specifically, no-cost preventive care. Beneficiaries should know they’ll pay nothing for some preventive services like annual wellness visits, flu shots, and certain cancer screenings, among other services.

9. Can agents use a sign-in sheet at a marketing event? Are food and drinks allowed?

It’s a good practice to put out a sign-up sheet at your formal marketing events. After all, you’re marketing a plan, and hoping to help beneficiaries enroll. However, secret shoppers have caught some agents who aren’t indicating that sign-up sheets are optional. Be sure that the sheet itself conveys that message, as well as your words and actions. Health insurance agents can’t require anyone to provide their contact information at these events, but you can certainly suggest it.

You may also serve food and drinks at your formal marketing events. However, be wary of two rules: the nominal value rule, which states that you can’t spend more than $15 per attendee on any combination of food, drinks, and giveaways; and the bundling rule, which prohibits you from offering anything that could be construed as a meal. Pizza’s a meal, making it a no-go at these events. But, you can absolutely put out a selection of beverages and baked goods. A little home cookin’ never hurt anyone, right?

Do it the right way, every time

Hosting a formal marketing event for your Medicare prospects and clients can seem daunting. Fortunately, carriers and Action Benefits help simplify things—we both have a vested interest in your success. Reach out to our team of experts for assistance in reporting your marketing events, promoting them, and even running through the script.