Study guide
9.3 Permitted vs. Prohibited Marketing & Sales Activities
AHIP Medicare Certification Exam
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1 Introduction
1.1 About the AHIP Medicare Certification Exam 1.2 How to Use This Study Guide
2 Chapter 2: Medicare Program Fundamentals
2.1 What Medicare Is: Program Structure & How Parts A–D Fit Together 2.2 Medicare Part A — Hospital Insurance 2.3 Medicare Part B — Medical Insurance 2.4 Medicare Eligibility Rules (Age 65, Disability, ESRD, ALS)
3 Chapter 3: Medicare Enrollment Periods
3.1 Initial Enrollment Period (IEP) 3.2 Annual Enrollment Period (AEP): October 15 – December 7 3.3 Medicare Advantage Open Enrollment Period (MA OEP): January 1 – March 31 3.4 Special Enrollment Periods (SEPs) & Qualifying Life Events 3.5 Late Enrollment Penalties (Part A, Part B, Part D)
4 Chapter 4: Medigap & Coordination of Coverage
4.1 Medigap (Medicare Supplement) Basics & Guaranteed Issue Rights 4.2 Dual Eligibility & Medicare Savings Programs 4.3 How Original Medicare, MA, Part D & Medigap Interact
5 Chapter 5: Medicare Advantage Plan Types
5.1 Medicare Advantage (Part C) Overview: How MA Differs from Original Medicare 5.2 HMO & HMO-POS Plans 5.3 PPO Plans 5.4 PFFS Plans (Private Fee-for-Service) 5.5 MSA Plans (Medicare Medical Savings Accounts) 5.6 Cost Plans & Employer Group Waiver Plans (EGWPs)
6 Chapter 6: Special Needs Plans & MA Plan Design
6.1 Special Needs Plans (SNPs) Overview 6.2 D-SNP — Dual-Eligible Special Needs Plans 6.3 C-SNP & I-SNP — Chronic Condition & Institutional Special Needs Plans 6.4 MA Benefits, MOOP & Supplemental Benefits 6.5 MA Star Ratings & Plan Quality
7 Chapter 7: Part D Structure & the 2026 Redesign
7.1 Part D Overview & Eligibility 7.2 Formularies & Drug Tiers 7.3 The 2026 Part D Benefit Redesign ($2,100 OOP Cap, $615 Max Deductible, Catastrophic Phase) 7.4 Medicare Prescription Payment Plan (Drug-Cost Smoothing)
8 Chapter 8: Part D Costs, Assistance & Appeals
8.1 Low-Income Subsidy (LIS) / Extra Help 8.2 Part D Late Enrollment Penalty & Creditable Coverage 8.3 Coverage Determinations, Exceptions & Appeals
9 Chapter 9: CMS Marketing Rules & Scope of Appointment
9.1 CMS Medicare Communications & Marketing Guidelines (MCMG) Overview 9.2 Scope of Appointment (SOA): the 48-Hour Rule & Exceptions 9.3 Permitted vs. Prohibited Marketing & Sales Activities 9.4 Marketing Events vs. Educational Events
10 Chapter 10: Enrollment & Disclosure Requirements
10.1 The Pre-Enrollment Checklist (PEC) 10.2 Enrollment Procedures & Application Requirements 10.3 Call Recording & Third-Party Marketing Organization (TPMO) Disclaimers 10.4 Agent & Broker Compensation Rules
11 Chapter 11: Marketing Conduct & Oversight
11.1 Cross-Selling Restrictions & Nominal Gift Value Rules 11.2 Marketing to Vulnerable Populations & Non-Discrimination in Sales 11.3 Website, Social Media & Advertising Compliance 11.4 Complaint Tracking Module (CTM) & Agent Oversight
12 Chapter 12: Understanding Fraud, Waste & Abuse
12.1 Defining Fraud, Waste & Abuse (and the Difference Between Them) 12.2 The False Claims Act 12.3 The Anti-Kickback Statute
13 Chapter 13: Compliance Laws & Screening
13.1 The Stark Law (Physician Self-Referral) 13.2 HIPAA Privacy & Security Basics 13.3 The OIG Exclusion List & Sanctioned-Provider Screening
14 Chapter 14: Reporting, Compliance Programs & Consequences
14.1 Detecting & Reporting FWA 14.2 Compliance Program Requirements (Seven Core Elements) & Non-Discrimination Training 14.3 Consequences & Corrective Action Plans
9.3 Permitted vs. Prohibited Marketing & Sales Activities
Key Takeaways Explain This Topic AI
Permitted contact requires beneficiary-initiated contact, prior permission for that specific method, mass-media advertising, or attendance at a chosen marketing event
Cold calls, robocalls, unsolicited texts, and door-to-door solicitation are prohibited without the beneficiary's prior permission for that exact contact method
Cross-selling non-health products during a Medicare appointment is banned; it requires its own appointment and its own SOA
Nominal gifts are capped at $15 per item and $75 per beneficiary per year in aggregate; cash and cash equivalents are banned outright
Meals, health-screening inducements, claims of government endorsement, pressure tactics, and misleading comparisons are all explicitly prohibited
Last updated: July 2026
Why This Topic Matters
CMS built an explicit list of permitted and prohibited marketing tactics precisely because Medicare beneficiaries are a population CMS considers vulnerable to high-pressure sales. AHIP tests this list heavily using "would this be allowed" scenario questions, and it is also the area where real-world agent terminations happen most often. Knowing the bright lines here protects both the beneficiary and the agent's own book of business.
Permitted Contact Methods
An agent may make contact with a Medicare beneficiary when:
The beneficiary has given prior permission to be contacted by that specific method (e.g., filled out a lead card with a phone number and checked a box authorizing a call)
Contact is via mass media — direct mail, television, radio, print, or general digital advertising that is not targeted one-to-one without consent
The beneficiary initiates contact themselves (calling in response to an ad, walking into an office, referral from an existing client who provides the beneficiary's information with consent)
- Contact occurs at a marketing/sales event the beneficiary chose to attend
- Prohibited Marketing & Sales Activities
Prohibited Activity Why It's Banned
Unsolicited door-to-door contact No permission was given for in-person contact; even leaving materials at a home when no one answers is prohibited (an exception exists only if an appointment was already scheduled and the beneficiary isn't home)
Cold calling / robocalls / unsolicited texts Telephonic contact without the beneficiary's prior permission for that specific contact method is banned outright
Cross-selling non-health products in the same appointment Discussing life insurance, annuities, or other non-health products during a Medicare sales appointment is prohibited; it requires a separate appointment with its own SOA
Gifts above nominal value Gifts/promotional items are capped at $15 per item and $75 per beneficiary per year ; cash and cash-equivalents (gift cards convertible to cash) are banned regardless of amount
Meals Providing a meal as part of a marketing event is prohibited; light snacks/refreshments are permitted
Health screenings as a sales inducement Using a "free health screening" to gather leads or induce attendance/enrollment is prohibited
Claiming government endorsement Agents may not imply they are calling on behalf of Medicare, CMS, or "the government," or use the word "official" (e.g., "official Medicare plan")
Pressure tactics Scare tactics, high-pressure closing, or implying a beneficiary will lose current benefits if they don't enroll now are prohibited
Misleading statements Providing inaccurate or misleading information about a plan or making misleading comparisons to other plans/carriers
The Nominal Gift Rule in Detail
The $15-per-item / $75-per-year rule is one of the most specific numeric facts tested on the exam. It applies per beneficiary, per year, across all plans/agents from the same parent organization — a beneficiary cannot receive a $15 item from five different agents representing the same carrier and have each treated as a separate $15 allowance; CMS looks at the aggregate from the sponsoring organization. Promotional items must be available to all attendees regardless of whether they enroll, and cannot be tied to enrollment (e.g., "enroll today and get a $50 gift card" is a prohibited inducement regardless of the dollar figure, because it conditions the gift on an enrollment decision).
Referral Rules
Existing clients may refer friends and family, and an agent may act on that referral once the referred beneficiary gives permission to be contacted — that permission satisfies the "prior permission" test above. What agents may not do is pay a referral fee, bonus, or anything of value to a current enrollee (or anyone else) that is contingent on the referral resulting in enrollment . A flat "thank you for being a client" gift unrelated to referrals is fine within the nominal-gift limits; a payment or reward specifically for producing a referral that enrolls crosses into an inducement and can also implicate the Anti-Kickback Statute covered later in this guide. Agents also may not ask existing enrollees to distribute plan-specific marketing materials to other beneficiaries on the plan's behalf without that activity itself going through the same MCMG rules that apply to the agent directly.
Exam Scenario
An agent hosts a community appointment and, partway through discussing a Medicare Advantage plan, the beneficiary mentions wanting to also look at final expense life insurance. The agent should stop the current conversation regarding life insurance , note it for a future date, and schedule a separate appointment with its own SOA to discuss the non-health product — continuing to discuss both products in the same appointment is a cross-selling violation regardless of how the topic came up.
In a second scenario, an agent wants to thank enrollees with a $20 branded tote bag. This exceeds the $15 per-item nominal gift cap and is prohibited even though it is not cash — the per-item cap applies regardless of what the item is.
Key Takeaways
Permitted contact requires beneficiary-initiated contact, prior permission for that specific method, mass-media advertising, or attendance at a chosen marketing event.
Cold calls, robocalls, unsolicited texts, and door-to-door solicitation are prohibited without the beneficiary's prior permission for that exact contact method.
Cross-selling non-health products (life insurance, annuities) during a Medicare appointment is banned; it requires its own appointment and its own SOA.
Nominal gifts are capped at $15 per item and $75 per beneficiary per year in aggregate across the sponsoring organization; cash and cash equivalents are banned outright regardless of amount.
Meals, health-screening inducements, claims of government endorsement, pressure tactics, and misleading comparisons are all explicitly prohibited.