Every Medicare Advantage compliance program has a version of the same problem. The plan trains the agents. The agents pass the test. Then the agents go out into the world and do whatever they were already doing.

That is not entirely the agents’ fault. The rules are genuinely detailed. CMS updates them annually. And the gap between “passed AHIP training” and “compliant in the field” is wide enough to drive a very large enforcement action through.

This checklist covers the areas where agent and broker marketing compliance actually breaks down — not the stuff everyone already knows, but the requirements that consistently surface in CMS audits, secret-shopper calls, and plan sponsor enforcement actions.

Training and Certification: More Than an Annual Test

CMS requires that every agent and broker selling Medicare Advantage products complete annual training and testing on Medicare rules, regulations, and the specific benefits of each plan they sell. The requirement applies to employed agents, subcontracted agents, downstream entities, and TPMOs — the full chain.

The training obligation is codified in the CY2026 Agent and Broker Training and Testing Guidelines published by CMS. Plans and TPMOs must ensure compliance at every level of the distribution chain, including delegated entities, under 42 CFR §§ 422.2274(c) and (g).

What trips plans up here is not the training itself — it’s the documentation. CMS wants evidence that agents completed training before they began selling. Not a few weeks into the enrollment period. Before. Retroactive attestations are not the same thing as timely compliance, and CMS treats them differently.

Also worth watching: agents who are licensed in multiple states must meet each state’s specific appointment and licensing requirements in addition to the federal training requirements. An agent licensed in Kansas and Missouri is not automatically compliant in both states because they passed one test.

Sales Event Rules: The Ones CMS Tests

CMS runs a secret-shopper program specifically targeting sales and marketing events. Agents get called. Calls get scored. When the score is bad, it is the plan sponsor — not the agent — that hears about it.

The required disclosures at individual marketing and sales events are specific. Agents must disclose the Medicare Part B premium obligation. They must explain Late Enrollment Penalties for Part D if applicable. They must note the plan’s Star rating if the beneficiary asks. They must record all individual marketing and sales calls.

The ones that get missed most often are the subtler requirements. Agents cannot conduct health screenings at marketing events. They cannot compare their plan to competitors’ specific benefits unless the comparison is accurate and CMS-approved. They cannot provide cash, gift cards, or gifts that exceed the nominal gift threshold — $15 per item and $75 annually. And they cannot solicit beneficiaries who did not request contact, even informally.

That last one generates violations at scale. Lead generation practices that blur the unsolicited-contact line are common. When a TPMO generates a lead through a method CMS considers solicitation, every downstream agent who calls that lead has a potential violation — and the plan sponsor owns it.

Marketing Materials: What Approved Actually Means

An agent using a flyer that the plan approved is compliant. An agent using a flyer that was approved six months ago but has since been superseded is not. An agent using a version they modified themselves — even slightly — is definitely not.

CMS requires that all marketing materials used by agents and brokers be approved through the Health Plan Management System (HPMS) before use. Materials that reference or promote more than one plan require HPMS submission and approval regardless of who created them. This applies to TPMOs creating multi-plan comparison materials, which is common and commonly non-compliant.

The approval date matters. Materials approved for the prior plan year cannot be used in the current year without re-approval. Benefit details change. Premium amounts change. Star ratings change. An agent showing a 2025-approved flyer in a 2026 enrollment event is using a document that may contain inaccurate information — and the plan is responsible for what that agent tells a beneficiary.

The Compensation Compliance Layer

Agent and broker compensation for Medicare Advantage enrollment is capped by CMS. The current structure allows a base referral fee for new enrollments and a lower amount for renewals, with adjustments for partial-year coverage. Plans cannot pay above those limits, and payments conditioned on enrollment volume, health status of enrollees, or steering beneficiaries toward specific plans trigger OIG scrutiny under the Anti-Kickback Statute.

The OIG’s Special Fraud Alert from October 2022 is still the controlling guidance here. It flagged arrangements that look like performance bonuses but are functionally payments for referrals — a distinction that matters considerably when a regulator is looking at your TPMO compensation contracts.

Plans that restructured compensation arrangements after the 2024 Texas federal court injunction on the broker compensation cap rule should note that the injunction affected one specific regulatory provision. It did not change the OIG’s analysis of kickback risk. Arrangements that were borderline before the injunction are still borderline.

What an Oversight Program Actually Requires

The regulation — 42 CFR § 422.2274 — requires plans to maintain oversight programs for agents, brokers, and TPMOs. Not just training. Not just contracts. Active, documented oversight.

That means monitoring what agents are actually publishing and saying in the market. It means tracking whether TPMOs are submitting required monthly disciplinary action reports. It means having defined escalation procedures when patterns of non-compliance emerge, and actually escalating, because CMS requires plans to report non-compliant agents and TPMOs, not just document the problem internally.

The difference between a plan with a compliance program and a plan with a compliant compliance program is usually found in this layer. The paperwork is often fine. The monitoring of what happens after the paperwork is signed is where most plans have gaps.

Monitoring is the Part You Cannot Outsource to the Agent

Here is the thing about agent and broker compliance: the agent’s job is to sell. Your job is to know what they are selling and how they are selling it. Those are not the same job, and they do not get done by the same process.

IntegriShield monitors 100M+ pages per month across every consumer-facing channel — agent websites, landing pages, social profiles, ad placements, comparison sites, and more. We eliminate 100% of client review burden through full-service remediation, which means when we find a violation in an agent’s active marketing, we handle the remediation. The plan team does not have to chase it.

We have been doing this for Medicare Advantage and insurance clients since 2012. The violations on this checklist are not theoretical. They are the ones we find repeatedly, at plans of every size, in distribution networks of every structure.

If your current oversight program consists mostly of contracts and annual training confirmations, this checklist is the gap analysis.

Find us at integrishield.com.

—

For more insights on marketing compliance, follow IntegriShield on LinkedIn to stay ahead of emerging risks, regulatory changes, and industry best practices: https://www.linkedin.com/company/integrishield/