What Is a Medicare Scope of Appointment?

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  • If you’re considering signing up for a Medicare Advantage or Medicare Part D plan in person, you’ll need to sign a Medicare Scope of Appointment before meeting one-one-one with a Medicare insurance agent. This form protects you from unwanted solicitations and ensures the agent focuses on the plans that interest you. Learn how the Scope of Appointment protects you and why you should sign it.

Think of the last time you received a phone call or in-person visit from a salesperson pressuring you to buy a product or service you probably didn’t need. It’s a stressful experience that most of us try to avoid.

Fortunately, you don’t have to worry about this when choosing a Medicare Advantage (Medicare Part C) or Medicare Part D drug plan. That’s because when you meet with a Medicare insurance agent in person to talk about these plans, Medicare requires your agent to collect a Scope of Appointment document.

The Medicare Scope of Appointment is like an agenda for your meeting. It’s a form that you and your Medicare insurance agent sign in person or electronically that clearly identifies what specific Medicare insurance products you want to learn more about. If your meeting is over the phone, then your recorded verbal consent may suffice. This article discusses the purpose of the Medicare Scope of Appointment and what you can expect.

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What Is the Purpose of the Medicare Scope of Appointment?

The Scope of Appointment document serves to record an in-person meeting with a beneficiary, guaranteeing that the discussion remains focused solely on the products initially requested and avoids any deviation into other product categories.

It helps ensure you get the information you need to make an informed decision about which Medicare Advantage plan and/or Medicare Part D plan is right for you. It limits your discussion to the scope of healthcare products you agree to in advance.

This means that your Medicare insurance agent isn’t allowed to try and sell you more than you need. They’re only allowed to talk with you about the plans you specified in the Medicare Scope of Appointment.

Is the Medicare Scope of Appointment Required for Original Medicare?

No, it is not required for enrollment in Original Medicare (Medicare Part A and Part B). It is required for Medicare Advantage, Medicare Supplement Insurance (Medigap plans, Medicare Part D drug plans, Hospital Indemnity and Dental/Vision/Hearing plans.

What Are the Requirements for a Valid Medicare Scope of Appointment?

Medicare doesn’t require a specific format, but it does require insurance agents to capture the following information: Date of the appointment; products you’ll discuss during that appointment; beneficiary and agent contact information; and a statement indicating there is no obligation to enroll, that current or future Medicare enrollment status is not affected by your decision, and that enrollment will not occur automatically. Both you and your Medicare insurance agent sign this form or agree to it verbally.

Will I Be Asked to Sign an Additional Medicare Scope of Appointment at Some Point in the Future?

You may be asked to sign an additional Medicare Scope of Appointment if you request information regarding a different plan type than what you specified originally.

For example, you might initially only be interested in a Medicare Advantage plan. However, as your health needs evolve, you may want to consider a Medicare Part D drug plan. At that point, you’d need to sign a new Scope of Appointment so your Medicare insurance agent can discuss Medicare Part D options with you.

If you are discussing plans with an insurance agent over the phone, you may be asked to verbally agree.

When Do I Fill Out the Medicare Scope of Appointment?

You must fill it out prior to the appointment with your Medicare insurance agent, or a licensed agent must verbally cover the Scope of Appointment with you if you’re talking over the phone.

What Happens if I Don’t Fill Out a Medicare Scope of Appointment?

If you agree to a Scope of Appointment, your Medicare insurance agent is not allowed to proceed with the meeting. Your agent is legally required to obtain this form.

What Happens if I Sign a Medicare Scope of Appointment, and an Agent Tries to Sell Me a Product I Did Not Agree to Discuss?

If your agent doesn’t follow Medicare’s rules, you can call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. You can also contact your State Health Insurance Assistance Program.

What Can I Expect During a One-On-One Meet With a Medicare Agent?

During your meeting – and after you sign or agree to the Medicare Scope of Appointment – your Medicare insurance agent may provide you with plan materials, talk about the plans you specified in your Scope of Appointment form, explain how to get more information, provide an enrollment form, help you complete the enrollment form (if you decide to move forward), and leave their business card for you to give to friends and family.

You can learn more about Medicare Advantage plans available where you live and compare available plans by calling to speak with a licensed insurance agent. You can also compare plans online for free with no obligation to enroll.

About the Author

Lisa Eramo is an independent health care writer whose work appears in the Journal of the American Health Information Management Association, Healthcare Financial Management Association, For The Record Magazine, Medical Economics, Medscape and more.

Lisa studied creative writing at Hamilton College and obtained a master’s degree in journalism from Northeastern University. She is a member of the American Health Information Management Association, American Academy of Professional Coders, Society of Professional Journalists, Association of Health Care Journalists and the American Society of Journalists and Authors.

Lisa currently resides in Cranston, Rhode Island with her wife and two-year-old twin boys.

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