The Medicare Scope of Appointment (or SOA for short) is a document that Medicare beneficiaries are required to fill out and sign prior to meeting with an advisor. It allows them to specify exactly which topics or insurance products they would like to discuss during the appointment. Essentially, this form ensures that advisors only cover the products the beneficiary is interested in. It helps protect individuals from being offered policies that might not suit their needs.
Benefits of a Medicare Scope of Appointment?
When Medicare Part D was introduced in 2006, it marked the first time retail prescription drug coverage was available to Medicare beneficiaries. Before this, for over four decades, Medicare didn’t provide substantial coverage for routine prescriptions. This new opportunity allowed over 20 million people to join a drug plan for the first time.
However, during this period, some beneficiaries raised concerns about their interactions with certain agents regarding drug coverage. With such a large influx of new enrollees, some unscrupulous agents saw an opportunity to exploit the situation to make quick sales.
Some Medicare beneficiaries reported feeling pressured or intimidated into signing up for specific plans. In some cases, people who intended to enroll in a Part D plan ended up enrolled in a Medicare Advantage plan instead. Since Medicare Advantage plans have lock-in periods, those affected were often stuck with these plans for up to a year. Additionally, some agents pushed non-Medicare products, like life insurance, during these discussions.
In the most extreme instances, agents forged signatures or used outdated information from deceased individuals to complete enrollments fraudulently.
The Centers for Medicare and Medicaid Services (CMS) does not tolerate such unethical behavior. In response to these issues, CMS introduced the Scope of Appointment form to ensure agents are held accountable and to safeguard Medicare beneficiaries from these practices.
These issues eventually led to Congressional hearings, prompting CMS to introduce new regulations that clearly outline acceptable practices.
Scope of Appointment Guidelines
Initially, the SOA was designed solely for in-person meetings. However, it is now required for virtual meetings as well, whether conducted by phone or video call.
It’s important to note that this form is only necessary if the appointment will involve discussions about Medicare Advantage or Part D products. If the conversation will focus on other products, such as Medigap or dental insurance, a Scope of Appointment form is not required by CMS.
When an agent or broker reaches out to discuss Medicare Advantage or Part D plans, they must first secure your consent using the Scope of Appointment form. This consent must be documented at least 48 hours before the meeting to ensure compliance.
However, if the Medicare beneficiary initiates contact with the agent or broker, the 48-hour rule does not apply. In such cases, a signed Scope of Appointment is still required, but it can be obtained at the time of the meeting rather than in advance. In addition, an SOA is not required during the last four days of certain enrollment periods, like the Annual Election Period.
The Scope of Appointment Form
On the Scope of Appointment form, beneficiaries can indicate which types of coverage they want to discuss with the agent. If a specific type of policy is not selected, the agent is prohibited from talking about that insurance option during the meeting.
Below are the types of products typically listed on a Scope of Appointment form:
- Stand-alone Part D Prescription Drug Plans
- Medicare Advantage Plans (Part C)
- Dental, Vision, and Hearing Plans (DVH)
- Hospital Indemnity Insurance
- Medicare Supplement Plans
You’ll need to either initial or check the boxes next to the items you want to discuss. The agent is required to submit this form along with any enrollment form you complete for a Medicare Advantage or Part D plan.
If you’re uncertain about which Medicare plans are right for you, it’s perfectly fine to select all the options on the Scope of Appointment form.
Avoiding Fraudulent Medicare Agencies
Unfortunately, some advisors or brokers may still try to bend the rules, so it’s important to exercise caution when dealing with one. Always ensure that the advisor is adhering to Medicare’s Scope of Appointment regulations.
If you’re considering working with an advisor, check their reviews to see what other clients have experienced. Be wary of anyone asking for unnecessary personal information, such as your Social Security or bank account details, as this is not required for a Scope of Appointment.
A trustworthy agent, following CMS guidelines, will always provide a Scope of Appointment form before discussing Medicare Advantage or Part D products with you.
Review Your Medicare Plans Today!
The Annual Election Period is the perfect time to review your Medicare coverage and ensure you’re on the right plan. Our team at Carolina Senior Benefits is here to help you navigate your options and find the best fit for your needs. Call our office today to schedule a personalized Medicare review with one of our experienced agents. Don’t miss this opportunity to make sure you’re getting the most out of your coverage!
