A Scope of Appointment is a form that Medicare brokers must fill out before a marketing appointment with a potential enrollee. This is to help protect enrollees from unfair sales practices and scams.

If an individual is looking to make changes to their privately managed Medicare plan, it is important that they work with a licensed insurance broker or agent who follows the rule of the Scope of Appointment (SOA).

This means the broker or agent will use the SOA form to document every in-person meeting or phone call they have with an individual. This also limits the interactions to certain agreed-upon topics.

A Medicare broker is required to submit an SOA form 48 hours before a personal marketing meeting.

A marketing meeting is an appointment an individual sets with a broker or agent of an insurance company to discuss private plan options. These plan options include:

Most marketing appointments take place in the person’s home. However, an agent or broker may set up a meeting in a coffee shop, library, or other agreed-upon location.

The SOA rules and requirements do not apply during an initial call to a broker or if a person shows up unexpectedly at a prescheduled marketing event.

When filling out an SOA form, a broker or agent must include the following:

  • the individual’s contact information
  • the broker’s contact information
  • the date and time of the appointment
  • the types of plans due for discussion during the meeting

They must also include statements that note:

  • The broker will not exert any pressure on the individual to enroll.
  • The meeting will not involve automatic enrollment in any plans.
  • The meeting will not affect the individual’s current or future Medicare status.

The SOA form is valid for 12 months from the date the broker or agent fills it out.

However, if an individual chooses to speak with the broker or agent about anything other than what they agreed to in the original SOA, they will require a new SOA form. If needed, the individual can fill in the new form during the marketing appointment.

Medicare brokers and agents are not allowed to:

  • Ask for personal information over the phone unless it is to enroll an individual in a plan.
  • Show up at a person’s home uninvited to sell or endorse anything.
  • Call an individual unless they have given permission or are already a member of a plan.
  • Require a person to speak to a sales agent to get information about a plan.
  • Offer cash or gifts valued over $15 to entice a person to sign up for a plan.
  • Offer meals as an incentive to sign up.
  • Ask for payment over the phone or online, as plans must send a bill.
  • Claim to be a representative for Medicare Supplement Insurance (Medigap), as they are not allowed to discuss non-Medicare products unless specifically asked.
  • Sell non-health-related products, such as life insurance.
  • Make an appointment to discuss their plans unless the individual agrees, and they cannot sell any products they did not previously agree on.
  • Talk with individuals about plans in plces such as exam rooms, pharmacy counters, and hospital waiting rooms.
  • Advertise to individuals without using specific plan names.
  • Advertise using confusing words, images, or misleading Medicare logos.
  • Market their plans or enroll individuals at educational events like a health conference.

A note on licensing

The state must license Independent brokers and agents who sell plans. The plan must also tell the state which agents are selling it.

During a marketing meeting, a broker or agent may:

  • give the individual materials, such as:
    • educational materials
    • the plan’s enrollment kit
  • tell the individual where to find more information on the plan, including:
    • website
    • business cards
    • customer service number
  • discuss various plan options
  • provide and collect enrollment forms if the individual is eligible to enroll

After the meeting, the broker or agent may call the individual to confirm that they want to join the plan and understand how it works. The broker may also call to discuss other plan options.

Extra rules for PFFS plans

If a Medicare agent or broker is selling private fee-for-service (PFFS), plans must:

  • Include written information with a complete description of how the plan works.
  • Make it clear that doctors or hospitals are not guaranteed to agree to the plan’s terms and conditions or provide care if a person joins the plan.
  • Send a letter with information on how to disenroll from the plan if the individual is unavailable by phone.
  • Have people available to answer questions about the plan.

Medicare resources

For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.

Medicare brokers and agents are required to fill out an SOA form 48 hours before a marketing meeting. The SOA also details certain rules and regulations for what they can and cannot discuss during a meeting.

The SOA is in place to help protect individuals from scams and unfair sales practices.

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