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NABIP Medicare study materials
NABIP Medicare study resources

NABIP Medicare: Medicare Compliance and Selling Season Readiness

NABIP Medicare · Work through your exam, one topic at a time.

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Medicare Compliance and Selling Season Readiness

Domain 4 covers the calendar you sell against and the CMS marketing rules you sell under. Exam items here tend to be practical: which election period applies, what effective date results, and whether a marketing tactic is permitted.

The calendar

  • Annual Enrollment Period (AEP): October 15–December 7, with elections effective January 1.
  • Medicare Advantage Open Enrollment Period: January 1–March 31, one change only, from MA to another MA or from MA back to Original Medicare with a PDP. It cannot be used to go from Original Medicare into an MA plan.
  • Initial Coverage Election Period for the newly eligible, aligned with the seven-month IEP.
  • Special Election Periods: loss of creditable coverage, moving out of the service area, dual-eligible or LIS status, a plan leaving the market, or a 5-star plan.

Marketing rules

Cold calls, unsolicited door-to-door contact, approaching beneficiaries in parking lots or waiting rooms, and sales presentations in health care settings are prohibited. A Scope of Appointment must be documented before an MA or PDP appointment, and only products listed on it may be discussed. CMS guidance requires a separate appointment at least 48 hours later if Medigap and an MA or PDP plan are both being considered. Third-Party Marketing Organizations must use the required disclaimer and record enrollment calls, retaining recordings for ten years. Gifts must be nominal - no meals regardless of value, never cash. Marketing materials must be filed with the plan and CMS 45 days before use, and no material may imply Medicare endorsement.

Worked example

A beneficiary calls November 20 wanting to move from her MA-PD to a different MA-PD. That is AEP: submit the enrollment, and it takes effect January 1. If instead she calls February 10, she is in the MA Open Enrollment Period - one change, effective the first of the following month, and going back to Original Medicare would require adding a PDP at the same time.

Traps

Promising a December 1 effective date for an AEP enrollment; using the January–March window to enroll a beneficiary in MA for the first time; accepting a Scope of Appointment signed at the start of the appointment; and assuming gift limits do not apply to low-cost items like snacks or transportation.