In the competitive world of health insurance, the way agents and agencies reach potential clients has changed dramatically. Not because of tech trends or shifts in consumer behavior — but due to increasingly strict regulations designed to protect Medicare beneficiaries.
Over the past two years, the Centers for Medicare & Medicaid Services (CMS) have implemented new rules that are transforming how marketing is conducted in this sector. These aren’t just suggestions — they are mandates that are reshaping everything from carrier contracts to the messages that appear on social media.
Beyond Promotion: Marketing Under Scrutiny
For CMS, advertising and promotion of Medicare plans can’t just be persuasive. It must be accurate, transparent, and closely monitored. This perspective is clearly reflected in the regulations in place for the 2024 and 2025 cycles.
One of the most significant changes is the requirement for one-to-one consent. Third-Party Marketing Organizations (TPMOs), including independent agencies that generate leads, can no longer share a beneficiary’s information with multiple agents without explicit written permission. This means obtaining a unique, documented consent for each data transfer — greatly limiting the common practice of purchasing contact lists or shared leads.
For many agents, this has brought a drastic shift in their lead acquisition strategy. Now they must invest more time and resources into generating their own contacts directly, while also maintaining records that prove the beneficiary gave specific permission.
New Requirements for Marketing Materials
CMS has also tightened control over marketing materials. Good intentions or generic language are no longer enough. Every piece — from social media ads to printed brochures — must be submitted for review and approval before being used.
This includes social media posts, explainer videos, call scripts, promotional emails, and websites. If the content mentions benefits, prices, deadlines, or provider networks, it must comply with CMS guidelines. Even common phrases like “the best plan available” may be considered misleading unless supported by approved data.
For agents, this means campaigns must be planned well in advance, and they must work closely with their FMOs or carriers to ensure everything is compliant before launch.
Increased Oversight on Calls and Meetings
The rules also increase requirements around interactions with beneficiaries. If a phone call is used to explain plans or initiate the enrollment process, it must be recorded in full. This applies to both inbound and outbound calls — and even virtual meetings, like those held via Zoom or Google Meet.
The only exception is in-person meetings. However, in those cases, documentation of what was discussed is still required, whether through a signed form or written note.
This measure aims to prevent aggressive or confusing sales practices and to protect beneficiaries from undue pressure. For agents, though, it creates an additional workload: they need recording systems, secure storage, and clear policies for handling client data.
Contracts, Incentives, and Compensation Under Review
Another important change lies in how CMS regulates agent compensation. In recent years, some plans offered incentives based more on enrollment numbers than service quality. That’s no longer allowed.
As of 2025, incentives based solely on enrollment volume are prohibited. CMS requires that compensation align with legitimate activities like education, support, or client follow-up. Furthermore, the definition of “compensation” has been expanded to include administrative payments such as training, materials, or support — all now subject to regulatory caps.
This rule ensures that agents act in the best interest of the beneficiary, rather than being swayed by fluctuating commissions tied to specific products.
Real Day-to-Day Implications
All these changes add up to a full transformation of agency operations. It’s no longer viable to use the same ad year after year, nor is it feasible to rely solely on intermediaries for lead generation.
Agents must become more strategic, more organized, and above all, more responsible in how they present information.
This involves:
- Redesigning workflows with realistic approval timelines
- Adopting tools for recording, storing, and managing documents
- Re-training teams to communicate clearly and without ambiguity
- Eliminating phrases or visual elements that could be misleading
- Establishing formal processes to collect and store one-to-one consents
A New Standard of Professionalism
While these changes may seem restrictive at first, they also present a great opportunity. Those who adapt will not only avoid penalties — they’ll position themselves as ethical, trustworthy, and better-prepared agents.
The health insurance industry is moving toward a higher standard of professionalism. In that context, agents who comply, educate, and respect the process will become the ones beneficiaries trust most.
At the end of the day, trust remains the most valuable asset. And in a tightly regulated environment, that trust is what truly sets professionals apart.
