CMS has updated its marketing rules and regulations for Medicare Advantage and Part D. The 2024 Final Rule (issued on April, 5, 2023) focuses on reducing deceptive practices in response to thousands of consumer complaints.
The following rule changes go into effect on September 30, 2023.
New Rules for Educational Events
Agents may not distribute SOAs or set appointments at Medicare educational events. They may distribute PTCs, BRCs, and business cards. A marketing event must not occur within 12 hours of an educational event at the same site.
New 48-Hour SOA Rule
There must be a 48-hour cooling-off period between receiving an SOA and scheduling an appointment. There are exceptions to the rule, such as unscheduled walk-ins and when a beneficiary is nearing the end of a valid enrollment period.
SOAs Valid for 12 Months
SOAs and BRCs will be valid for 12 months. Agents will need to keep track of the start and end dates – your CRM tool should be able to do this for you. After 12 months, you will need to update your permission to contact.
Unannounced Door-to-Door Contact Still Prohibited
CMS clarified that collecting a BRC does not give an agent permission to knock at a beneficiary’s door without a scheduled appointment.
Benefits Marketing Must Include the Sponsors’ Name
Marketing materials for plan-specific benefits must clearly display the names of the MA or Part D sponsors.
Marketing Must Target Beneficiaries in the Plan’s Service Area
When agents are marketing plans and benefits, they may only target beneficiaries who are in the plan’s service area. This is particularly important when marketing five-star plans, SNPs, and Part B giveback plans.
There is an exception when targeting outside the service area is “unavoidable” due to the coverage of the advertising medium. For example, a TV ad that airs in a certain geographic area could also reach beneficiaries outside the plan’s service area.
Restrictions on the Use of Superlatives in Marketing Materials
Agents must refrain from using superlatives such as “best”, “most”, “lowest”, etc. to describe plans unless they can back up the statement with data from the current or previous year.
Clarification on Call Recording Requirements
CMS offered additional clarification on call recording rules. Agents only need to record calls they make for marketing, sales, and enrollment purposes. They do not need to record follow-up calls, such as for checking ID cards or for scheduling appointments. Agents do need to record virtual calls (including video conference calls), but only the audio content, not the video.
Restrictions on the Use of “Medicare” and CMS Logo
Due to concerns that beneficiaries may be confused and believe they are dealing with representatives of the federal government, CMS is curtailing the use of the word “Medicare” and the CMS logo in ways that may be misleading. Since CMS plans to hold carriers responsible for any inappropriate use by agents and brokers, it is likely that carriers will not approve of any marketing materials that include use of the word “Medicare,” except when describing specific products – such as Medicare Advantage and Medicare Supplement. This means agents will need to remove the wording from their business name, URL, and logo.
Updated TPMO Disclaimer
CMS has updated the required disclaimer. You must now add your state’s SHIP as an additional source of information and the disclaimer must include the number of organizations the TPMO represents as well as the number of plans. The disclaimer must be specific to a beneficiary’s service area.
For TPMOs that do not sell all MA and/or Part D plans within a service area, the disclaimer is:
“We do not offer every plan available in your area. Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all your options.”
For TPMOs that sell all MA and Part D plans within a service area, the disclaimer is:
“Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. You can always contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) for help with plan choices.”
You must use the disclaimer on all marketing materials. This includes websites and digital and print materials. It must appear in email and online chat communications, and agents must add it to their script to use within the first minute of a phone call.
New Enrollment Requirements
Whenever a client makes a new enrollment decision, agents must explain how that decision will impact their current coverage.
CMS will also require agents to ask a list of standardized questions before enrolling a beneficiary in a plan.
There will be more guidance coming from CMS on how agents must implement both of these requirements.
You Don’t Have to Navigate the Changes Alone
PTT Financial is here to help you prepare for these changes and ensure you stay compliant. Contact us today.