For Aetna Medicare Distribution Partners



February 24, 2023

In this issue:

  • Caution to agents: Do not steer clients based on "scheduling fees"
  • Reminder: You can only require a zip code or county, and other location information from clients to review plans

Steering based on scheduling fees

CMS is concerned that some Medicare Advantage sales agents are being reimbursed a scheduling fee by a primary care provider (PCP) group for scheduling PCP appointments for clients who are new patients of the group. You should never steer a client's enrollment choice based on scheduling fees or other reimbursement offered by a provider.


Remember your role:

  • Plan review: Find available health plan options for your clients.
  • Enrollment: Help clients select and enroll in a plan that best meets their health care needs. 
  • PCP selection: Assist clients to select a provider if they don't have one at the time of enrollment. The PCP must be accepting new patients and selection should be based on clients' personal preferences, such as PCP office proximity.
  • Your plan review, enrollment and PCP selection with your client should not in any way be driven by a scheduling fee or other reimbursement that you may be offered by a provider. 

The do's and don'ts for helping a client search for a plan


Remember: Medicare Beneficiary Identifiers (MBI) and Social Security Numbers (SSN) are NOT required

While your overall goal is to enroll beneficiaries into Medicare plans, many beneficiaries may not be ready to enroll when you speak with them. Some may call to obtain basic information and then need time to determine what plan to choose. Others may not be ready to provide key information such as their MBI.


What you can ask during an informational call:

  • You may only require a prospect to provide their primary state of residence, zip code or county, and any location details that may be necessary if their zip code covers two different plan service areas.

What you CANNOT ask during an informational call:

  • You are NOT permitted to require your client's MBI as a prerequisite for reviewing plans in their area.  
  • Additionally, if your client doesn't know their MBI, you may NOT require they provide their SSN in order for you to look up their MBI. 

If a beneficiary refuses to provide their MBI or SSN, you must continue with the call and review plans based on the location information, and any information they choose to share about their eligibility for Medicare, Medicaid or Extra Help, to help determine which best suits the beneficiary's needs.

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance and its affiliates (Aetna). 


Prior to engaging in the sale of Aetna Medicare products, producers must be ready to sell, which means certified, contracted, licensed in the applicable states, and appointed by Aetna in accordance with state law. As permitted in certain states, Aetna will order appointments after the first sale. This communication is intended for use by brokers only and is not intended for distribution to Medicare beneficiaries. Any publication or distribution of this communication to unauthorized recipients without Aetna’s approval is prohibited..


You are receiving this because you have elected to communicate with Aetna through email. If you no longer wish to receive these particular messages via email, you may unsubscribe at any time. 
We are located at 151 Farmington Ave, Hartford, Connecticut 06156. 
©2023 Aetna Inc.