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Provider Education

Marketing in a Healthcare Setting

Providers treating Medicare patients are required to follow a set of rules and standards established by the Centers for Medicare and Medicaid Services (CMS). These rules guide what you may and may not do in regard to discussing Medicare Advantage health plans with your patients.

CMS is concerned with provider marketing activities for the following reasons:

  1. Provider may not be fully aware of all plan benefits, rules and costs.
  2. Provider may confuse the patient because he/she perceives the provider as acting as an agent of the plan versus acting as the person’s provider.
  3. Providers may face conflicting incentives when acting as a plan sponsor representative.

Providers can be subject to audit by CMS and/or SummaCare. SummaCare is also subject to liabilities based on the provider’s marketing activities. All providers who contract with SummaCare to provide Medicare Advantage services are expected to abide by the Centers for Medicare & Medicaid Services (CMS) rules for marketing when it involves SummaCare products or benefits. The below guidelines are applicable to providers.

Please note: All participating providers (also referred to as first-tier or downstream entities) existing and new that will be displaying or providing marketing materials on behalf of SummaCare must complete a Provider Marketing Attestation Form.

Activity: Talking to Patients About Healthcare Options

Providers May:

At the request of a patient or as a matter of a course of treatment:

  • Provide the names of plan sponsors with which they contract and/or participate.
  • Answer questions or discuss the merits of a plan or plans, including cost sharing and benefits information (these discussions may occur in areas where care is delivered.)
  • Refer patients to Plan marketing materials available in common areas.
  • Provide information and assistance in applying for the Low Income Subsidy.

If asked:

  • Provide objective information about all health care options (remain neutral when presenting patient with options).
  • Let patient know of any partnerships.

Provide resource material or refer patients to:

  • Plan Sales Agent
  • CMS: or 1-800-Medicare
  • State Health Insurance Assistance Program (SHIP): Ohio Senior Health Insurance Information Program, 1-800-686-1578.
  • Social Security: 1-800-772-1213
  • Medicaid: Ohio Jobs and Family Service: 1-800-324-8680, TTY 1-800-292-3571

Providers May Not:

  • Make phone calls/mail or persuade patients to enroll in a specific plan based on any financial or other interests of the provider.
  • Give items of value to a patient to select a particular plan over another.
  • Give items of value to an enrollee to select them as their provider.
  • Conduct health screenings as a marketing activity.
  • Accept compensation from a plan for beneficiary enrollments.

Activity: Sales Activities

Providers May:

  • Allow Sales Agents to give sales presentations and conduct marketing activities, including having a table in common areas like Hospital Lobbies, Cafeterias, Community or recreational rooms, and Conference rooms including office waiting rooms.
  • Allow Sales Agents to distribute marketing materials and/or accept a BRC (Business Reply Card) from a beneficiary to contact at a later time.

Providers May Not:

  • Allow Sales Agents to conduct presentations and marketing activities in healthcare settings where patients primarily intend to receive health care services. Restriction applies both during and after normal business hours.
  • Accept or distribute Scope of Appointment forms from a patient.
  • Offer to fill out the sales lead forms/BRCs.
  • Accept or distribute enrollment forms on behalf of the plan.

Activity: Distribution and Display of Marketing Materials

Providers May:

  • Make available and/or distribute plan marketing materials.
    • Marketing materials are used to draw a beneficiary’s attention to a plan and include their decision. Marketing can materials contain information about a plan’s benefits structure, cost-sharing, rankings, etc.
  • Display marketing posters or other health plan / sales agent materials in common areas such as the provider’s waiting room.
    • Providers are free to determine which type of materials it will make available and/or distribute.
  • Providers must make available and/or distribute materials from all of the plans with which it participates.
  • Share information with patients from CMS’ website, including the “Medicare and You” Handbook or “Medicare Options Compare,” or other documents that were written by or previously approved by CMS.

Providers May Not:

  • Show preference towards certain contracted health plans in regards to displaying their marketing materials.
  • Accept or distribute enrollment forms on behalf of the plan.
  • Distribute marketing materials or enrollment forms within an exam room, patient room, treatment area or pharmacy counter area.

Activity: Distribution and Display of Marketing Materials

Providers May:

  • Make available, distribute and display communication materials including in areas where patient care is being delivered.
    • Communication materials are used to provide information to current or prospective enrollees. It is not intended to influence a beneficiary’s decision-making process. Communication materials do not contain any marketing content such as benefit structure, cost-sharing, etc.


  • If providers display a list of contracted Medicare plans, it must be inclusive of all plans. This creates equal opportunity for all accepted plans should you not have materials for each plan.
  • Should a patient specifically request printed materials on a specific plan's benefits, direct them to the common area where plan materials are available.
  • You may discuss any and all Medicare options available to any Medicare beneficiary, as long as the discussion is objective and factual and does not steer a patient to a particular plan or set of plans.
  • Physicians and their employees must remain neutral in assisting patients with health plan choices and enrollment decisions. Health plan materials should be made available equally on site and only in common spaces where no specific services are being provided.

Source: Code of Federal Regulations (CFR) Title 42; Chapter IV, Subchapter B/Part 422/Subpart V/ 422.2266  (September 2021)

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