Each year, CMS reviews their policies for Medicare Advantage and Part D sales and then issues a final ruling on what's changing for the upcoming year. On April 5th, CMS released their 2024 Final Ruling for Medicare Advantage and Part D. CMS updated some requirements, as well as clarifying a few past updates. These rules will go into effect on September 30th, 2023 for marketing 2024 plans. Even though these are not in effect yet, it is okay to go ahead and start applying these to your marketing.
Here are some changes that might effect you as an agent:
Marketing Rules
- CMS placed limits around using certain Medicare assets (Name, logo, and Medicare card) in a way that may confuse beneficiaries.
- TPMOs must get approval from carriers prior to submitting marketing materials to HPMS.
- Marketing materials cannot advertise benefits in areas where they are not available, unless it is unavoidable because of use of local or regional media that covers the service areas.
- Marketing Materials cannot advertise savings based on a comparison of typical expenses of uninsured individuals.
- Plans represented by a marketing material must be listed on the material.
- Benefits mentioned in materials must mention specific benefit amounts and must include the names of the Medicare Advantage Organization (MAO) or Part D sponsors.
- Marketing and communication materials cannot use superlatives (ex. best, most, largest, lowest) unless the material provides documentation to support the statement.
Permission to Contact & SOAs
- Even with a PTC (Permission to Contact) or BRC (Business Reply Card), an agent cannot show up unannounced at a beneficiary's home. There must be a scheduled appointment for a specific time with the beneficiary.
- There must be 48 hours between an SOA (Scope of Appointment) and an appointment. Exceptions include if a beneficiary is approaching the end (within the last 4 days) of a valid enrollment period and walk-ins.
- SOAs and BRCs are only valid for a 12 month time frame (from the beneficiary's signature date or their request for more info). You will need to get a new SOA or PTC if the original has expired.
Call Recording
- CMS clarified the requirement for recording all calls. Only sales and enrollment calls need to be recorded starting September 30th, 2023. Appointment setting or checking in after the sale do not have to be recorded. Virtual meetings, such as Zoom and Facetime, is included as a call that will need to have the audio recorded.
Disclaimers
- The TPMO disclaimer now applies to ALL TPMOs, including those offering only one plan for all plans in an area.
- Agents must add SHIP to the TPMO disclaimer, as well as listing the number of plans and products they represent in the area the beneficiary is in.
- If you’re marketing Medicare Advantage or Part D insurance products, you must include the appropriate revised TPMO disclaimer below on all marketing materials (print and electronic), website, and within the first minute of audio scripts or calls.
- Here is a sample of the new disclaimer:
- "We may not offer every plan available in your area. Currently we represent [insert # of MA organizations] Medicare Advantage organizations which offer [insert # of plans] different plan options in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP), to get information on all of your options."
Educational and Sales Events
- A marketing/sales event cannot be within 12 hours of an educational event at the same location.
- You cannot set future marketing appointments or collect SOAs at an educational event.
- You CAN collect BRC or PTC if requested by an attendee at an educational event.
There are a few more provisions in the ruling, such as the Pre-Enrollment Checklist rules and annual opt-outs from plan business. There are some clarifications that we expect to be answered in future sub-regulatory guidance. We know that these changes will effect all of us as we do business this coming year, but we hope this helps you be prepared before the rules are in effect in September. If you have any questions, please reach out to us at info@eisgroup.net.
View the full Ruling on the Federal Register