Medicare Scope of Appointment Rules

Summary: The Medicare Scope of Appointment is a mandatory form that beneficiaries and potential beneficiaries must sign before meeting with an insurance agent to discuss Medicare Advantage options. Also known as the Medicare 48-Hour Rule, it’s in place to protect you from high-pressure situations and scams. Estimated Read Time: 10 mins

Table of Contents:

1. What Is a Scope of Appointment for Medicare?
2. How Long Is a Scope of Appointment Good For?
3. Electronic Medicare Scope of Appointment Form
4. CMS Scope of Appointment Guidelines
5. Telephonic Scope of Appointment
6. How Long Must a Scope of Appointment Form Be Kept
7. How To Avoid Scams With Your Medicare Scope of Appointment

In order to protect beneficiaries, Medicare has various rules and guidelines in place to help avoid high-pressure situations and scams. When it comes to making changes to your Medicare Advantage plan, many beneficiaries are looking to work with a licensed insurance agent. However, you’re going to need to be aware of the Medicare Scope of Appointment when doing so.

These days, there are several ways that we communicate. Therefore, different types of meetings may be set up between an agent and a beneficiary like you. Regardless of the type of meeting being held, understanding how the Scope of Appointment applies is crucial to making the appropriate changes in your healthcare for the following year.

It’s also worth mentioning that thanks to the 2024 CMS final rule, important changes are going to affect how you enroll in Medicare Advantage (Medicare Part C), Medicare Part D prescription drug plans, or Medicare Supplement plans. Navigating these changes doesn’t have to be overwhelming. Below, we’re reviewing the Medicare Scope of Appointment requirements, changes, and everything you need to know about setting your appointment with a trusted professional.

What Is a Scope of Appointment for Medicare?

The Medicare Scope of Appointment is a requirement for in-person and over-the-phone appointments. If you’re working with a licensed insurance agent to enroll in or change Medicare Advantage coverage, the Scope of Appointment Medicare must be presented to document the meeting. This may also be referred to as the Medicare 48-Hour Rule.

Agents must document their meetings with both potential and current beneficiaries using the Medicare Scope of Appointment form. The SOA form remains on file for ten years and protects all parties. It can also be collected verbally.

Sadly, many people have used a sales approach to profit from misunderstandings in the insurance world. Medicare Scope of Appointment rules are in place so that bad actors can be weeded out and to protect people like you from falling victim to scams.

However, you can also benefit by helping your agent get to know your needs a bit better before you sit down to make the actual changes. The 48-Hour Rule Medicare requires is also a good time for your agent to prepare material for the meeting that can help you better understand the right options for your needs.

You’ll fill out the form at least 48 hours before an agent is able to discuss plans with you or comes to your home. The SOA form lets the agent know beforehand which coverage options are open for discussion. It’s also important to note that if you don’t select one of the coverage options on the Scope of Appointment Medicare requires the agent to avoid discussing it with you unless you fill out a new SOA form.

The SOA protects you and the agent. When an agent uses this form and sells you a policy, they can use e SOA to say that you only discussed the things that were determined to be up for discussion. Be sure to always fill a form out before the meeting and to do so thoroughly to ensure your agent can review all the coverage options you may have questions about. This is a requirement before any set appointments, or unexpected calls/meetings.

How Long Is a Scope of Appointment Good For?

Your Medicare Scope of Appointment is good for 12 months from the date of signing. However, it’s important to note that you can’t speak about coverage you don’t elect to when filling out your Scope of Appointment, without signing a new one.

For example, if you wish to discuss different Medicare Advantage plans, fail to elect Medicare Supplement plans, but discover that you would like to explore those options after all within the 48-hour waiting period, you’ll need to sign a new SOA in order to proceed. Therefore, your timeline would restart. This includes any other policy regulated by the federal Medicare system.

Electronic Medicare Scope of Appointment Form

To help ease the SOA form process, CSG Actuarial developed an Electronic Scope of the Appointment Process. The method includes an automated storage system and a backup plan that adheres to all standards for compliance. Insurance agents can obtain the information, search for their Scope of Appointment forms, and save all documents within this platform. They can even use this program to obtain quotes for you.

Your previous Scope of Appointment documents can also be uploaded into the electronic system to maximize proficiency. As a beneficiary, you must ensure to initial all checkbox selections. Simply checking the box is inadequate. An agent can only discuss options initialed by you and cannot pressure you into buying anything beyond what you’ve agreed to review.

To ensure you get all the information you want, we use a similar form to the Scope of Appointment form. Since agents are unable to utilize the electronic Scope of Appointment form during telephone consultations, our team here at MedicareFAQ uses verbal SOAs before proceeding.

Our goal here at MedicareFAQ is to make sure you get access to and knowledge about the insurance plan that’s best suited for you. Our form indicates which insurance you want to discuss.

Medicare Advantage plans are an alternative to Medicare and usually include Part D. Part D plans cover the costs of prescription drug costs you’d otherwise pay. Medicare Supplement plans work hand in hand with Medicare to pick up the out-of-pocket costs that Medicare doesn’t cover. Vision, Dental, and Hearing plans are separate insurance policies that offer routine care.

Hospital Indemnity plans are the insurance plans that cover your hospital visits and stays. Long-Term Care Insurance comes in handy if you need custodial care. We’ll need to record the best number to reach you at your full name and the best email address for you. All this information then goes to one of our agents; they reach out to you, assist you with all your questions, and provide you with a quote.

Plan rates vary depending on location, so this information is critical in providing you with the most accurate quote. Also, health history can affect cost and eligibility for different plans.

CMS Scope of Appointment Guidelines

Legally, to discuss insurance plans, you’ll need to complete a Medicare Scope of Appointment form. However, what that looks like is changing thanks to the 2024 CMS Final Rule. Here’s everything you need to know about the latest Medicare Scope of Appointment rules:

• The SOA rules apply to agents and brokers meeting with you to discuss coverage options and plans. It goes into effect September 30, 2023.
• Essentially, it takes away potential high-pressure situations by providing a 48-hour period between initiating the meeting and marketing actually taking place.
• Agents are also allowed to contact you after the initial Medicare SOA takes place, but only up to 12 months after at most.
• Beneficiaries and potential beneficiaries can also opt out annually.

The Medicare Scope of Appointment 48-Hour Rule changes allows your agent an opportunity to better prepare for your meeting and gives you an opportunity to consult with your loved ones, caregivers, and conduct due diligence.

It’s important to note that while the CMS Scope of Appointment guidelines are in place, there are two notable exceptions:

• If you are in the final four days of an election period, you’re allowed to have a same-day SOA.
• Furthermore, if you walk into an insurance agency or brokerage and initiate the conversation about your coverage, there is still a need for an SOA but you don’t have to wait 48 hours. Walk-ins are exempt from having the 48-hour waiting period.

Telephonic Scope of Appointment

To ease any stress that the SOA process may bring, you can choose a telephonic meeting. As a consumer, you can speak with your agent via telephone and consent to an oral agreement. Your phone recording will then serve as a Scope of Appointment.

Under these conditions, the following criteria apply to your Medicare Scope of Appointment:

• Unless a beneficiary calls in, the waiting period is exempt.
• Each agent gets an SOA that is good for up to 12 months. Even if you drop a call, so long as the same agent reaches out, the SOA stands.
• However, a new Scope of Appointment is necessary if additional benefits are to be discussed within that timeframe.

How Long Must a Scope of Appointment Form Be Kept?

A Scope of Appointment form must remain on hand for ten years by your agent. You can request a copy of this form and get a copy without any issues. This will help you in the event there is an issue or dispute. Remember, the Medicare Scope of Appointment is in place to provide consumers like you with peace of mind and protection.

How To Avoid Scams With Your Medicare Scope of Appointment

There is no reason for you to put up with high-pressure situations or scams when shopping for healthcare. Securing the coverage you need should be an educational process that helps you manage costs, risks, and provides peace of mind. Your Medicare Scope of Appointment is a tool that helps you accomplish all of this. Here’s how:

Work With a Licensed Agent That Proves Legitimacy

If you’re working with a licensed agent that is offering you a SOA, you’re in a good place. It’s the right thing to do and a requirement from the Centers for Medicare & Medicaid Services (CMS). However, you can double-check by running the agent’s license number online. Each state has its own resources but starting with your state’s Department of Financial Services is a great place to start.

In addition to looking up an insurance agent, it’s also a good idea to look for red flags. Even if your agent presents you with the Scope of Appointment Medicare requires, should they ask to bend or outright break the rules, you’re likely not dealing with a person who has the right intentions for your healthcare or budget.

Conduct Due Diligence on the Carrier

Your SOA provides you with time to conduct research on the carrier you either are reenrolling with or enrolling with for the first time. The same goes for brokers, you’ll want to be sure you’re working with a reputable company. Taking advantage of the Medicare 48-Hour Rule gives you plenty of time to make sure everything is on the up and up.

Assess Your Needs and Speak With Trusted Loved Ones

Part of your enrollment journey should include looking at your needs and discussing them with loved ones and caretakers when necessary. Seeking advice from trusted loved ones can help you look at both your budget and your healthcare needs from multiple perspectives. Knowing what you need is a great way to avoid high-pressure situations when signing up for coverage.

Here at MedicareFAQ, all our insurance agents are licensed and provide the Medicare Scope of Appointment when handling Medicare Advantage and prescription enrollment. We are here to educate and respect the rules laid out by CMS to provide you with safe and viable options when shopping for your coverage. Give us a call at the number above or click the compare plans button below to find rates in your area.

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