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This guide is for training purposes only and should be used in conjunction with current CMS guidelines and carrier-specific compliance requirements. All agents must stay up-to-date with the latest Medicare regulations and compliance standards. The examples provided are for illustrative purposes and should be adapted according to specific situations and requirements.

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Consent for Enrollment

Category: Compliant Medicare Sales Calls

Last Updated: March 12, 2025

CMS Reference:

• 42 CFR § 422.2262(a)(1)(i),(iii) & 422.2268 (a)(1),(2) (Prohibits misleading or inaccurate information)
• 42 CFR § 422.2262(a)(1)(x) & 422.2268(a)(6) (Requires plan names to include plan type)
• 42 CFR § 422.2274(c)(9)(i) (Requires confirming beneficiary understanding)
• MMCM CH 2: 40.1.3, 40.4.1, & Appendix 2 (Requires providing plan name and details during enrollment)
• MMCM CH 2: 30 (Election Periods and Effective Dates)
• MMCM CH 2: 40.2 (Processing the Enrollment Request and confirming the effective date)
• MMCM CH 2: 40.1.3 & 40.2 (Requires verbal attestation of intent to enroll)

Overview

Before a beneficiary is enrolled in a Medicare Advantage (MA) plan, they must provide explicit consent to enroll and confirm their understanding of the plan’s name, type, and effective date.

Agents must:

✅ Ensure the beneficiary understands the product before completing enrollment.

✅ Clearly state the full plan name, including the plan type (e.g., HMO, PPO, SNP).