Updated October 2026 | For Licensed Insurance Agents
Medicare compliance is an essential part of building a successful, sustainable insurance business. As the Medicare landscape continues to evolve, independent agents must stay informed about CMS marketing regulations, documentation requirements, consumer protections, and carrier-specific guidelines.
For the 2027 plan year, the Centers for Medicare & Medicaid Services (CMS) introduced several important changes affecting Medicare Advantage (MA) and Part D marketing activities. These updates include revised Scope of Appointment procedures, changes to educational and sales event requirements, updated Third-Party Marketing Organization (TPMO) disclosures, and new call-recording retention standards.
Whether you're preparing for the Annual Enrollment Period (AEP), reviewing existing clients' coverage, or expanding your Medicare business, understanding these requirements helps protect your clients, your reputation, and your business.
This guide covers the key compliance areas Medicare agents should understand for 2027, along with practical recommendations and resources from PSM Brokerage.
CMS finalized several changes to Medicare marketing and communications regulations under CMS-4212-F, applicable to contract year 2027 marketing materials beginning October 1, 2026.
Important updates include:
These changes provide additional flexibility, but agents must continue following CMS regulations, applicable state laws, and carrier-specific policies.
Agent Resource: Visit the PSM Compliance Resource Center for compliance guidance, forms, and additional resources.
One of the most important compliance distinctions involves understanding the difference between general communications and marketing.
Communications generally provide information about Medicare, healthcare coverage, or plan operations without meeting CMS's definition of marketing.
Marketing is a subset of communications involving activities or materials intended to draw attention to an MA or Part D plan and influence a beneficiary's enrollment decision, subject to the applicable regulatory criteria.
Examples of marketing may include:
Not every communication requires CMS submission or approval. Requirements depend on the material's classification, applicable CMS filing rules, and carrier procedures.
Best Practice: Before publishing or distributing Medicare-related materials, confirm whether they are classified as communications or marketing and whether carrier review, CMS submission, or approval is required.
Agents should avoid modifying carrier-approved marketing materials without authorization.
Explore PSM's Marketing Hub for agent marketing resources and support.
The Scope of Appointment process helps ensure beneficiaries understand which Medicare product categories will be discussed during a personal marketing appointment.
For 2027, CMS eliminated the former 48-hour waiting period, allowing personal marketing appointments to take place after the required SOA has been completed.
Key requirements include:
An SOA is not a blanket authorization to discuss unrelated insurance products or conduct unrestricted future marketing.
Agent Tip: Use compliant electronic documentation tools when appropriate and maintain an organized record of appointment authorizations.
For additional guidance, review PSM's Medicare Scope of Appointment Resource and Compliance Center.
Educational and marketing events serve different purposes and remain subject to different CMS requirements.
Educational events are intended to provide general Medicare information without steering attendees toward specific plans.
Agents should:
Under the 2027 rules, agents may collect SOA forms at educational events, subject to applicable requirements.
Marketing events may include plan-specific information, benefit presentations, and enrollment discussions, provided the applicable CMS and carrier requirements are satisfied.
CMS now permits a marketing event to immediately follow an educational event at the same location, provided attendees receive appropriate notification that the educational event has ended and have a sufficient opportunity to leave before marketing begins.
Important: An SOA is not automatically required simply because someone attends a properly conducted public sales event. SOA requirements apply to qualifying personal marketing appointments.
Agent Tip: Maintain documentation of event classifications, promotional materials, carrier reporting, and required attendee notifications.
Independent agents and agencies operating as Third-Party Marketing Organizations must understand when the CMS TPMO disclaimer is required.
The standardized disclaimer helps beneficiaries understand that an agent or agency may not represent every available Medicare plan.
For 2027, CMS removed the reference to SHIPs from the required disclaimer and changed the timing requirement for applicable marketing calls.
The disclaimer must be verbally communicated before plan benefits are discussed, rather than automatically within the first minute of a call.
Agents should also:
Best Practice: Never reuse an outdated disclaimer without reviewing the current CMS language and carrier guidance.
Find additional guidance through the PSM Compliance Center.
CMS requires TPMOs operating on behalf of MA organizations and Part D sponsors to record covered marketing, sales, and enrollment calls in their entirety, including applicable audio interactions conducted through web-based technology.
For 2027, the federal retention requirement for covered recordings has been reduced to six years. Transcripts may be used in place of recordings for years four through six.
Agents should maintain procedures that address:
Not every administrative or customer service call automatically falls within the CMS sales and marketing recording requirement.
Agent Tip: Confirm that your phone system, enrollment platform, and documentation procedures support applicable recording and retention requirements before conducting sales activities.
Digital marketing remains an effective way for independent agents to build visibility, educate consumers, and generate interest in Medicare coverage.
However, Medicare-related advertising must remain accurate, transparent, and compliant.
CMS has revised certain restrictions involving superlatives such as "best" or "most." However, this does not authorize unsupported or misleading claims. Supporting evidence may still be required when requested.
Agents must distinguish between permitted communications and prohibited unsolicited marketing contact.
Do not assume that purchasing a lead, receiving a referral, or obtaining a general inquiry automatically authorizes every type of outreach.
Review applicable CMS requirements, TCPA rules, Do Not Call restrictions, state privacy laws, and channel-specific consent requirements before initiating marketing calls, texts, or direct messages.
Agent Resource: Explore PSM's Compliant Lead Resources and Marketing Resources to help build an effective outreach strategy.
Protecting beneficiary information is a fundamental responsibility for Medicare agents.
CMS regulations include restrictions on how TPMOs share beneficiary personal data with other TPMOs for marketing or enrollment purposes.
Where applicable, agents must obtain the beneficiary's prior express written consent before sharing personal data with another TPMO for those purposes.
Consent must be specific to the receiving TPMO and cannot be replaced with a broad, unrestricted authorization.
Agents should also:
Best Practice: Audit website forms, lead-generation campaigns, CRM workflows, and referral arrangements to ensure consent language accurately reflects how information is collected and shared.
Compliant Medicare sales involve more than presenting attractive benefits.
Agents must help beneficiaries understand relevant coverage details, costs, restrictions, and enrollment considerations.
Before enrollment, review applicable CMS-required information, including:
Avoid presenting supplemental benefits without explaining relevant eligibility conditions or limitations.
For Special Needs Plans, verify applicable eligibility requirements rather than assuming a beneficiary qualifies.
Agent Tip: Document the beneficiary's stated needs and the important plan information reviewed during the consultation.
For more sales preparation resources, visit PSM's Insurance Agent Training Center.
CMS maintains specific requirements governing marketing activities in healthcare settings and interactions with Medicare beneficiaries.
Marketing activities may be permitted in appropriate common areas, subject to applicable rules and facility policies.
Agents should not conduct prohibited sales activities in patient rooms, treatment areas, or other locations where individuals receive healthcare services.
Agents may request referrals when permitted, but must follow CMS restrictions concerning unsolicited outreach and referral incentives.
Receiving a referral does not automatically provide permission to contact the referred individual using an otherwise prohibited marketing method.
Medicare marketing appointments are subject to restrictions involving unrelated products.
Agents should not use a Medicare Advantage or Part D marketing appointment to market unrelated non-healthcare products in violation of CMS rules.
Separate appointments, appropriate permissions, and product-specific compliance requirements may apply.
Best Practice: Keep Medicare sales discussions focused on the beneficiary's agreed coverage needs and avoid combining unrelated sales activities without reviewing the applicable requirements.
Maintaining compliant sales practices begins before the first client appointment.
CMS requires applicable agents and brokers selling Medicare Advantage and Part D products to complete annual training and testing.
Agents should confirm:
Carrier requirements may differ, so agents should confirm their ready-to-sell status with each organization they represent.
Visit PSM's Certification Center for current training and carrier certification resources.
Use this checklist before launching campaigns, conducting appointments, or submitting Medicare enrollments.
Staying compliant should be part of your everyday business operations, not something you think about only during AEP.
At PSM Brokerage, we help independent agents navigate changing Medicare requirements with resources, training, marketing support, and experienced guidance.
Our goal is to help agents stay informed, operate confidently, and build stronger client relationships.
Explore these resources:
Medicare regulations will continue to evolve, but a commitment to accurate information, responsible marketing, and client-focused service remains essential.
By keeping your certifications current, maintaining proper documentation, reviewing marketing materials, and staying informed about CMS requirements, you can build a stronger foundation for long-term success.
With PSM Brokerage, independent doesn't mean alone.
Whether you need help understanding Medicare compliance requirements, preparing for AEP, or developing a compliant marketing strategy, our team is here to support you.
Explore PSM Compliance Resources
Compliance Notice: This article is intended for licensed insurance professionals and provides general educational information. It is not legal advice or a substitute for current CMS regulations, carrier guidance, or applicable state and federal laws. Agents should verify requirements with their carriers and compliance teams before implementing marketing or enrollment activities.