Medicare Compliance Check: What’s New for This AEP?

The Annual Enrollment Period (AEP) is always fast-paced, but that doesn’t mean you can afford to cut corners. Staying on top of Medicare compliance isn’t just about avoiding penalties. It’s about building long-term trust with your clients and protecting your business.

Each year, CMS updates or clarifies its guidelines, especially around marketing practices, beneficiary communication, and documentation. As a Medicare agent, it’s your responsibility to stay informed, follow the rules, and adapt your processes before AEP kicks off.

This blog will walk you through what’s new for compliance for AEP, plus the dos and don’ts of marketing and tips for keeping your client records audit-ready.

Why Medicare Compliance Matters More Than Ever

CMS isn’t just looking at what you say during appointments, it’s paying attention to how you promote yourself, how you collect leads, what you say in your materials, and whether you’re keeping accurate documentation.

Noncompliance can result in:

• Fines or revocation of your license
• Loss of contracts with carriers
• Damaged reputation and client mistrust
• Increased audits or oversight

Those who put compliance for Medicare agents first are more likely to retain clients, attract referrals, and stay in business for the long haul.

What’s New in CMS Guidelines for 2025 AEP

CMS typically releases updated guidelines in the Medicare Communications and Marketing Guidelines (MCMG) or through carrier announcements. While the exact updates can vary each year, here are a few key areas where changes are often made, and what to watch out for when preparing your compliance for CMS strategy:

1. Call Recording Requirements

The rule introduced in 2022 requiring agents to record all marketing-related calls with beneficiaries is still in effect. Some updates may clarify:

• Which calls are required to be recorded (initial intent-to-enroll and plan discussions)
• How long you must store recordings (typically 10 years)
• What technology is considered compliant

Tip: Make sure your phone system or CRM has a secure and trackable recording feature, and that you’re getting verbal consent at the beginning of each call.

2. Third-Party Marketing Oversight

If you’re using a third-party marketing organization (TPMO) or generating leads online, make sure your materials and scripts include the correct disclaimers and that all advertisements have been submitted to carriers for approval.

Required disclaimer example:

“We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer in your area.”

3. Scope of Appointment (SOA) Timing and Format

Scope of Appointment forms must still be obtained at least 48 hours in advance unless the beneficiary is walk-in or under certain exceptions. CMS has emphasized:

• Digital SOAs must be stored securely
• Pre-appointment SOAs must not be bundled with other forms
• Agents must not pressure clients into discussing topics outside the agreed scope

These changes underscore the importance of adhering to AEP protocols in a systematic and organized manner throughout every stage of your sales process.

Marketing Dos and Don’ts for AEP

A huge part of staying within compliance with CMS is making sure your marketing follows CMS rules. Here’s a quick refresher:

DO:

• Submit all marketing materials for carrier approval before use
• Use only approved scripts during outbound calls
• Clearly identify yourself as a licensed agent
• State that calling customers is optional and not required for enrollment
• Educate clients without pressuring them

DON’T:

• Use misleading language like “Medicare endorsed” or “government-approved”
• Advertise benefits that aren’t available in all areas without disclaimers
• Say plans are “free” unless you clarify that $0 premium plans still have costs
• Make uninvited door-to-door visits or leave materials on doorsteps
• Send cold texts or emails without permission

Even small mistakes can trigger big problems. Double-check everything before launch

How to Document Interactions Properly

Documentation is your best defense if you’re ever audited or questioned. It also helps you stay organized and serve clients better.

Best practices for documenting interactions:

• Record the date, time, and summary of every interaction
• Store Scope of Appointment forms and call recordings securely
• Log plan options discussed and final choices
• Track lead sources and how permission to contact was obtained
• Keep all documentation for at least 10 years

Using a compliant CRM system can make this process much easier, especially if it allows tagging, uploading signed documents, and tracking appointment history.

Adding proper documentation is a vital step in compliance for Medicare agents, particularly during the busy AEP season.

Staying Compliant Builds Trust

Medicare compliance isn’t just about rules—it’s about relationships. When clients know you follow the law, protect their privacy, and explain things clearly, they’re more likely to return and refer others.

Here’s what compliance for AEP signals to your clients:

• You respect their rights and choices
• You’re up to date on Medicare rules and plan changes
• You’re focused on long-term service, not just short-term sales

That kind of trust is priceless. And it sets you apart from agents who cut corners.

Final Thoughts

The best time to check your compliance for CMS is before AEP begins. Use this quiet period to review your marketing materials, update your CRM and recording tools, and refresh your understanding of Medicare compliance guidelines.

By staying compliant, you’re not just protecting your license, you’re building a stronger, more trustworthy business. So take the time now. Make the changes you need. And head into AEP with confidence, knowing you’re doing it right.