Medicare's Annual Enrollment Period (AEP) runs from October 15 through December 7 every year — and it is one of the most heavily solicited periods in American healthcare. Insurance agents, brokers, and Third-Party Marketing Organizations flood mailboxes, inboxes, and phone lines with offers to switch plans. For many beneficiaries, it is overwhelming. For some, it is predatory.
The Centers for Medicare & Medicaid Services (CMS) has established a comprehensive set of rules governing how agents and brokers can approach beneficiaries during this window. These rules exist to protect people who may not fully understand the consequences of switching plans — and whose healthcare coverage decisions can have life-altering implications.
What CMS Rules Actually Require During AEP
Two CMS regulations form the backbone of permissible Medicare marketing during open enrollment: 42 CFR § 422.2274 (Scope of Appointment) and 42 CFR § 422.2268 (Marketing Requirements). Both apply to Medicare Advantage plans; parallel rules under Part 423 govern prescription drug plans.
The Scope of Appointment Rule (42 CFR § 422.2274)
Before any face-to-face meeting with a beneficiary — including in-home consultations — a Medicare agent must first obtain the beneficiary's written or recorded consent specifying the type of plan discussion the meeting will cover. This is called a Scope of Appointment (SOA) record.
The SOA must be obtained through one of four methods:
- A signed paper form
- A recorded telephone signature
- An electronic signature through an approved system
- A recorded consent via an 800-number enrollment system
The SOA must be obtained before the meeting and must be retained for at least 10 years. If an agent shows up uninvited at a beneficiary's door during AEP — regardless of how helpful or well-intentioned — they are in violation of this requirement unless prior consent was documented.
Marketing Requirements (42 CFR § 422.2268)
CMS also prohibits a range of specific marketing activities during AEP. These include:
- Marketing materials that do not clearly identify the sponsoring organization
- Comparisons that disparage competing plans without factual basis
- Claims that a plan is "recommended by CMS" or government-approved (CMS does not recommend specific plans)
- Sending unsolicited marketing emails to beneficiaries
- Using the Medicare name or logo in a way that implies government endorsement
- Displaying Planfinder results that favor a specific carrier's products
The rules also restrict certain sales events. Agents cannot host a sales event in a way that creates pressure to enroll immediately — no "limited time only" pressure tactics, no free meals that create an implied obligation.
What Constitutes Prohibited Contact
Beyond the formal marketing rules, CMS guidance and its enforcement actions make clear what constitutes prohibited solicitation during AEP:
Unsolicited Phone Calls
Agents cannot initiate outbound telephone contact with a beneficiary unless the beneficiary has provided prior written consent to be contacted. This rule is distinct from — and in addition to — FTC telemarketing rules. For Medicare Advantage agents specifically, CMS enforces a stricter standard than general marketing law.
If you receive a cold call from someone selling Medicare Advantage plans during AEP and you did not ask for the call, that call is potentially a violation — regardless of whether the agent is on your state's approved agent list.
Door-to-Door Contact
CMS explicitly prohibits uninvited in-home visits by agents or brokers. The Scope of Appointment requirement exists precisely to prevent the situation where an agent arrives at a beneficiary's door without prior consent. Beneficiaries — especially those living alone or with cognitive decline — should understand that no legitimate Medicare agent will show up unannounced.
Misleading Mailers
Marketing materials that look like official government correspondence are prohibited. CMS requires that all Medicare Advantage marketing include clear disclosure that the materials are from a private insurance company, not the federal government. Mailers designed to look like Medicare Communications or that use "Official" language are direct violations.
Similarly, postcards or letters that imply a beneficiary is already enrolled in a new plan — when they are not — constitute deceptive marketing. Some agents send "confirmations" that beneficiaries must opt out of rather than opt into. This is prohibited.
How to Stop Unwanted Medicare Solicitation
If you are receiving unwanted Medicare solicitation during AEP, you have several options:
Report to CMS: The CMS complaint system accepts reports from beneficiaries, their authorized representatives, and attorneys. CMS investigates patterns of violations and can impose significant penalties — including removing the offending plan's ability to market in a service area.
Report to your State Insurance Commissioner: Every state has rules that supplement federal CMS requirements, and state insurance regulators have enforcement authority over licensed agents.
Work with an elder law attorney to document the contact: A formal written notice from an attorney — citing the specific CFR provisions violated and demanding that solicitation cease — carries legal weight that a consumer complaint does not. Attorneys can also issue notices on behalf of beneficiaries who lack the capacity to act for themselves, which is critical for clients with cognitive decline. For guidance on building this documentation system, see how elder law attorneys build their own Medicare do-not-contact registry.
Use PlanShield to register and document: PlanShield allows attorneys and authorized representatives to create a timestamped record of do-not-contact requests, generate formal notices with the correct CFR citations, and maintain a complete audit trail. This documentation is essential if violations occur and enforcement action becomes necessary.
The best protection is a documented record. If solicitation has already occurred, the ability to prove when the contact happened, who initiated it, and what was said is the foundation of any enforcement action.
What to Do If Your Plan Was Changed Without Consent
CMS has established a special enrollment period that allows beneficiaries who were enrolled without their consent to switch back to their original plan (or select a new plan) outside the normal enrollment window. If you discover that a plan switch was made without your authorization — including situations where an agent completed an enrollment form during an uninvited visit — you should:
- Contact the plan directly to dispute the enrollment
- File a complaint with CMS through 1-800-Medicare or the online complaint portal
- Contact your state insurance commissioner if a licensed agent was involved
- Document everything in writing, including dates, names, and what was discussed
- Consult an elder law attorney if the beneficiary lacks capacity or if the switch created significant harm
Elder law attorneys are particularly important in these situations because unauthorized plan switches often disproportionately affect beneficiaries who cannot advocate for themselves. An attorney can act as the authorized representative, communicate with the plan and CMS on the beneficiary's behalf, and build a documented case for why the enrollment should be reversed.
Enforcing Your Rights During AEP
The CMS rules governing Medicare AEP solicitation exist for a reason. Beneficiaries who rely on fixed incomes, manage multiple chronic conditions, and depend on consistent prescription coverage are the most vulnerable to aggressive — and sometimes deceptive — marketing tactics.
Knowing the rules is the first step. Enforcing them requires documentation, persistence, and in some cases, legal representation. Elder law attorneys are uniquely positioned to provide that representation — not only for individual beneficiaries, but for practices that want to establish proactive compliance programs before problems arise.
PlanShield was built for this. Attorneys use it to register clients in a documented do-not-contact system, generate legally-grounded notices citing 42 CFR provisions, and maintain records that hold up in regulatory proceedings. If you represent Medicare beneficiaries and are fielding solicitation complaints, the infrastructure already exists to act on their behalf.