The Scope of Appointment (SOA) process is a crucial aspect of Medicare marketing and sales activities designed to protect the interests of Medicare beneficiaries and ensure compliance with regulations. The SOA process is primarily associated with Medicare Advantage (Part C) and Medicare Prescription Drug Plans (Part D) but can also apply to other Medicare-related products.
What is the Scope of Appointment (SOA)?
The Scope of Appointment is a document that outlines the specific topics and types of information that a Medicare sales agent or broker intends to discuss with a Medicare beneficiary during a face-to-face or telephone appointment. It is a critical tool to ensure that the beneficiary understands the purpose of the meeting and has consented to discuss certain Medicare-related topics.
Purpose of SOA:
The SOA process serves several important purposes:
- Ensures that beneficiaries have control over the topics discussed during the appointment, preventing agents from presenting unwanted or unnecessary information.
- Helps prevent instances of coercion or aggressive sales tactics.
- Demonstrates compliance with Medicare regulations, specifically the Medicare Marketing Guidelines.
- Protects beneficiaries by ensuring they only receive information they've agreed to hear about.
When is an SOA Required?
The SOA process is typically required when a Medicare sales agent or broker wants to have a one-on-one, in-person or telephone conversation with a Medicare beneficiary to discuss specific Medicare-related products, such as Medicare supplement plans, Medicare Advantage plans or Medicare Part D prescription drug plans. It's important to note that unsolicited contact without an SOA can lead to penalties.
Completing the SOA Form:
To initiate the SOA process, the agent or broker must provide the beneficiary with an SOA form, which includes the following information:
- Beneficiary's name and contact information.
- Date of the appointment.
- The agent's or broker's name and contact information.
- A list of the specific topics or products that will be discussed during the appointment.
Obtaining Consent:
Before discussing any topics not listed on the SOA form, the agent or broker must obtain explicit consent from the beneficiary. The beneficiary can either agree to discuss the additional topics or decline.
Documenting the SOA:
The agent or broker is required to document the SOA process, including a record of the beneficiary's consent or refusal to discuss additional topics. Documentation is essential for compliance purposes and to provide a record of the beneficiary's choices.
The 48 Hour Rule:
Introduced in the autumn of 2023, the recently implemented 48-hour rule is designed to combat deceptive marketing tactics and safeguard the well-being of beneficiaries. As per the rule, agents are required to furnish beneficiaries with a Scope of Appointment (SOA) form at least two days prior to a scheduled appointment.
To adhere to the rule, beneficiaries must sign the SOA form at least 48 hours before their appointment. However, walk-in appointments and appointments that occur within four days of the end of the enrollment period are exempted from this requirement. It is important to note that Scope of Appointment forms remain valid for a period of up to twelve months from the beneficiary's signing.
Penalties for Non-Compliance:
Failing to adhere to the SOA process and other Medicare marketing regulations can result in penalties, including fines, suspension of sales activities, or revocation of agent/broker licenses.
It's important to note that the specific requirements and regulations regarding the SOA process can change over time. Therefore, Medicare sales agents, brokers, and organizations involved in marketing Medicare supplement plans should stay up-to-date with the latest guidance and requirements issued by the Centers for Medicare & Medicaid Services (CMS) to ensure compliance.
Steps to Medicare Scope of Appointment (SOA) Compliance
- Identify SOA Need
Confirm that the appointment involves discussion of Medicare Advantage or Part D plans — if yes, an SOA is required.
- Deliver the SOA Form
Provide the SOA form at least 48 hours before the scheduled appointment. This can be done in person, by email, via secure link, or physical mail.
- Explain the Purpose
Let the beneficiary know the SOA limits the topics you’ll discuss, and that it’s required by CMS to protect their rights.
- Collect and Document the SOA
Ensure the beneficiary completes and signs the form. Acceptable formats include:
→ Paper signature
→ Telephonic (recorded verbal consent)
→ Electronic (DocuSign or compliant e-signature platform)
- Confirm Valid Timing
Ensure the SOA was signed at least 48 hours prior to the appointment unless exempt (walk-ins or final 4 days of AEP).
- Retain the SOA
Store the completed SOA securely per CMS or carrier guidelines — typically 10 years. Retention method may be paper or digital.
- Only Discuss Approved Topics
During the appointment, discuss only the products checked by the beneficiary on the SOA form. If they request to cover additional topics, you must complete a new SOA.
- Repeat for Future Appointments
If more than 12 months pass or the scope changes, obtain a new SOA before your next appointment with that client.
Frequently Asked Questions (FAQ)
What is a Medicare Scope of Appointment form?
A Scope of Appointment (SOA) form is a CMS-required document that captures a beneficiary’s permission to discuss specific types of Medicare coverage—such as Medicare Advantage, Part D, or Medigap. It protects both the beneficiary and agent by clearly defining the scope of the appointment before any plan details are discussed.
Do I need an SOA for every appointment?
Yes—if the appointment involves discussion of Medicare Advantage or Part D plans. An SOA is required prior to each new appointment where these products are reviewed, unless it falls within the 12-month window of a previously signed SOA for the same beneficiary and topic.
What is the 48-hour SOA rule?
As of 2024, CMS mandates that the SOA form must be obtained at least 48 hours before the scheduled sales appointment. This rule gives beneficiaries time to review and understand what will be discussed. There are exemptions for walk-in meetings and appointments scheduled within the final four days of the Annual Enrollment Period (AEP).
How long is a Scope of Appointment valid?
An SOA form is valid for 12 months from the date it is signed, provided the scope of discussion doesn’t change. If you plan to present different products or services later, you must obtain a new SOA.
What happens if I don’t follow SOA rules?
Failure to comply with SOA rules may result in CMS sanctions, commission reversals, and potential loss of carrier contracts. It's also a serious compliance violation that can affect your credibility and license. Always document and store SOAs securely, and follow your FMO or carrier’s retention policy.
