CMS Marketing Guidelines 2026: What Every Medicare Agent Must Know

What Are the CMS Marketing Guidelines?

The CMS Medicare Communications and Marketing Guidelines (MCMG) are a comprehensive set of rules published under Chapter 2 of the Medicare Managed Care Manual and Chapter 3 of the Prescription Drug Benefit Manual. They define what constitutes "marketing" versus "communications," establish prohibited activities, and set requirements for every piece of material or interaction an agent has with a Medicare-eligible individual.

At their core, the guidelines exist to protect Medicare beneficiaries from misleading, deceptive, or high-pressure sales tactics. CMS views the Medicare-eligible population—predominantly seniors aged 65 and older, along with individuals with qualifying disabilities—as a vulnerable consumer group that requires heightened regulatory protection.

Every agent who is appointed by a Medicare Advantage or Part D plan is contractually bound to follow these guidelines. Plan sponsors are ultimately responsible for the actions of their downstream agents, which is why carriers conduct rigorous compliance training and require annual certifications. Ignorance of the rules is not a defense—CMS holds both the plan and the agent accountable.

Marketing vs. Communications: Understanding the Distinction

One of the most frequently misunderstood aspects of the CMS guidelines is the distinction between "marketing" and "communications." Under the current rules, marketing refers to any activity or material that steers or attempts to steer a beneficiary toward enrolling in a specific plan or limiting their options. Communications, on the other hand, are materials and activities that provide general information about a plan's benefits, structure, or operations without guiding the beneficiary toward a particular enrollment decision.

Why does this matter? Marketing materials must go through a CMS review and approval process before they can be used. Communications generally do not require prior CMS approval, although they must still comply with all applicable rules regarding accuracy and non-deception. Getting this classification wrong can result in an agent using unapproved marketing materials—a violation that CMS takes extremely seriously.

Telephone Marketing Rules: What You Can and Cannot Say

Telephone solicitation is one of the most scrutinized areas of CMS enforcement. The 2026 guidelines reinforce and expand the rules that dictate when, how, and what agents can communicate over the phone. If you sell Medicare plans over the phone—whether inbound or outbound—these rules apply to every single call.

What Agents CAN Do on Calls

What Agents CANNOT Do on Calls

For a deeper dive into call recording obligations that overlap with these marketing rules, see our complete Medicare compliance guide, which covers recording retention, state-by-state consent requirements, and CTM complaint avoidance.

Scope of Appointment (SOA) Requirements

The Scope of Appointment is one of the most critical compliance documents in Medicare sales. Before any marketing or sales appointment—whether in person, over the phone, or via video—the agent must obtain a completed SOA form that specifies which product types the beneficiary has agreed to discuss.

Digital and Online Marketing Rules

As more Medicare-eligible individuals become comfortable with digital channels, CMS has expanded its oversight of online marketing. The 2026 guidelines apply the same core principles to websites, social media, email campaigns, and online advertising that have always governed print and telephone marketing.

Every digital advertisement that mentions a specific plan by name, highlights specific benefits, or includes enrollment information is considered marketing material and must be filed with CMS through the Health Plan Management System (HPMS) before use. This includes paid search ads, social media posts, banner ads, landing pages, and email campaigns.

Print and Direct Mail Guidelines

Print materials remain one of the most common marketing channels for Medicare plans, particularly during the Annual Enrollment Period. Every printed piece—from brochures and flyers to door hangers and postcards—must comply with strict CMS formatting and content requirements.

All print marketing must be submitted to CMS for review through HPMS. Materials must use a minimum 12-point font size for body text, include the multi-language insert, and contain the standard CMS disclaimers. Benefit claims must exactly match the plan's Summary of Benefits document filed with CMS. Any deviation—even a minor wording change—can trigger a compliance action.

Common Violations and How to Avoid Them

CMS tracks complaints through its Complaint Tracking Module (CTM) and conducts regular audits of plan sponsors and their agent networks. Understanding the most common violations helps agents proactively avoid them. Here are the areas where agents most frequently run into trouble:

Event Marketing: Educational vs. Sales Events

CMS draws a sharp line between educational events and sales/marketing events. Understanding this distinction determines what you can say, what materials you can distribute, and whether you can collect contact information or enrollment applications.

Educational events are designed to inform beneficiaries about Medicare in general—how the program works, what coverage options exist, and how to evaluate plans. At an educational event, you may not steer attendees toward a specific plan, distribute plan-specific marketing materials, or collect Scope of Appointment forms. You may collect business reply cards (BRCs) so attendees can request follow-up information.

Sales/marketing events are intended to promote specific plans and facilitate enrollment. At these events, you may present specific plan benefits, distribute CMS-approved marketing materials, collect SOAs, and assist with enrollments. However, you must advertise the event as a sales event, and all marketing for the event itself must be CMS-filed and approved. You cannot disguise a sales event as an educational event—this is one of the most common and heavily penalized violations.

The Role of AI Compliance Monitoring

With the volume and complexity of CMS marketing rules continuing to grow, many forward-thinking agencies are turning to AI-powered compliance monitoring tools to protect themselves. Manual compliance review—listening to recorded calls, auditing printed materials, and reviewing agent scripts—is simply not scalable when your agency handles hundreds or thousands of beneficiary interactions per week.

AI compliance monitoring uses real-time speech analytics and natural language processing to flag potential violations as they happen on live calls. These systems can detect prohibited phrases ("This is the best plan," "You'll lose your benefits if you don't switch," "This plan is free"), identify when agents stray outside the Scope of Appointment, and alert supervisors to potential issues before they become CTM complaints.

To learn more about how AI-driven compliance tools work in practice, read our guide on AI-powered insurance compliance monitoring. For best practices on using call transcriptions as part of your compliance workflow, see our article on call transcription best practices for compliance teams.

Penalties and Enforcement

CMS enforcement of marketing guidelines has intensified significantly in recent years. The agency has multiple enforcement mechanisms at its disposal, and the penalties for violations can be severe enough to end an agent's career or bankrupt a small agency.

Civil Monetary Penalties (CMPs) can reach up to $112,000 per violation under current regulations, with CMS adjusting this figure periodically for inflation. A single marketing campaign that reaches thousands of beneficiaries can be treated as thousands of individual violations, compounding the financial exposure dramatically.

Plan-level sanctions can include suspension of marketing and enrollment activities, which effectively freezes the plan's ability to acquire new members. When a plan sponsor is sanctioned, every agent contracted with that plan is affected. In extreme cases, CMS can terminate the plan's Medicare contract entirely.

Agent-level consequences include termination of appointments with plan sponsors, placement on the CMS preclusion list (which bars an agent from participating in any Medicare program), and referral to state insurance departments for license revocation proceedings. Once an agent is on the preclusion list, their Medicare sales career is effectively over.

Preparing for AEP and OEP Under the 2026 Rules

The Annual Enrollment Period (October 15 – December 7) and the Open Enrollment Period (January 1 – March 31) are the busiest and most scrutinized times for Medicare marketing activity. CMS increases its monitoring efforts during these windows, and CTM complaint thresholds are closely watched.

Agents should begin preparing their AEP marketing strategies well in advance, ensuring that all materials are submitted to CMS for review by the carrier's internal deadlines—typically 60 to 90 days before AEP begins. Waiting until the last minute to submit materials risks having them rejected or returned for revisions, leaving you without approved marketing pieces when the enrollment period opens.

During enrollment periods, pay special attention to outbound calling rules. The volume of beneficiary interactions increases dramatically, and so does the risk of compliance errors. Implementing AI-powered mock call training before AEP can help agents practice CMS-compliant conversations and identify areas where they tend to drift into non-compliant language.

Key Takeaways

The 2026 CMS marketing guidelines represent a continued tightening of the rules governing how Medicare plans are promoted to beneficiaries. For agents, the message is clear: compliance is not a burden to be minimized—it is a competitive advantage that protects your business, your reputation, and the beneficiaries you serve.