We are committed to achieving and maintaining world-class levels of compliance and ethical business conduct. With all the rules and regulations governing the insurance industry today, marketing and selling compliantly can be a daunting task for agents. This is where we come in.
CMS has released the 2027 Medicare Advantage and Part D Policy and Technical Updates Final Rule, introducing changes that will directly impact plan strategy, compliance, Star Ratings and beneficiary experience.
The CMS 2027 Final Rule is about reducing friction while preserving strong consumer protections. The focus is no longer on rigid timing rules, but on clarity, transparency and consumer choice.
What Agents Need To Know — CMS Final Medicare Marketing Rules Summary
Most importantly, CMS does not finalize its proposal to prohibit TPMOs from distributing beneficiary contact information. Notably, CMS states that it is not even addressing or discussing this proposal in the final rule. This is excellent news.
The final rule was published in the Federal Register on April 12, 2023.
As we expected, the final rules are effective for marketing plans for Contract Year 2024.
As we also expected, CMS finalized most of its proposals either without modification or with just minor tweaks to the language.
CMS did, however, modify some of its proposals, and some modifications are helpful and provide more flexibility.
APRIL 2023 On Wednesday April 12, CMS published the Federal Register that included 2024 Policy and Technical Changes for the Medicare Advantage and Prescription Drug programs.
Below are some of the most impactful changes/clarifications that will affect you as an agent:
Scope of Appointment
Requires a Scope of Appointment to be obtained at least 48 hours prior to a sales meeting/appointment with a beneficiary – CMS noted two exceptions:
In-person Walk-ins
Beneficiary is within the last 4 days of a valid election period
Medicare Name, Marks, and Logo
Prohibits the use of Medicare name, CMS logo, or products or information issued by the Federal Government, including the Medicare card, in a misleading manner. Note: We should get more clarity on this as we move forward, and precedent is set.
Use of an image of the Medicare card will require prior approval from CMS.
Marketing Materials
Requires all carriers to approve “marketing” materials prior to HPMS submission (basically same process, as most larger carriers already required this last year – now applies to all carriers)
Prohibits marketing of benefits in a service area where those benefits are not available, unless unavoidable because of the use of local or regional media that covers the service area — we’re hoping carriers provide a little more clarity on this rule, we’ll keep you updated with what we hear
Marketing materials cannot advertise beneficiary savings based on comparisons to an uninsured individual
Requires TPMOs to list or mention all MA and/or Part D organizations that they represent on “marketing” materials – we’re hoping carriers provide a little more clarity on this rule as well, we’ll keep you updated with what we hear
Disclaimers
The TPMO disclaimer now needs to include SHIPs as an option for beneficiaries to obtain additional help.
The TPMO disclaimer must state the number of organizations (carriers) represented by the TPMO as well as the number of plans.
The TPMO disclaimer is now required even if the TPMO offers all plans in a service area but there is alternate language (it would be rare for an agent to actually offer all plans though)
NEW Disclaimer: “We/I do not offer every plan available in your area. Currently we/I 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 of your options.”
Educational Events
Prohibits a marketing/sales event from occurring within 12 hours of an educational event at the same location (same location means the same building or any adjacent buildings).
Prohibits scheduling future marketing appointments (individual sales appointments) at an educational events.
Prohibits the collection of Scope of Appointment forms at educational events
Clarifies that you may distribute and collect BRC / PTC (permission to contact forms) – the request to be contacted must be optional and at the request of the beneficiary.
Door Knocking
CMS clarified that a BRC or PTC (permission to contact) does not give an agent permission to show up unscheduled at a beneficiary’s residence.
There are several other provisions of the rule, such as enhanced Pre-Enrollment Checklist rules, a requirement that plans to create more robust agent oversight program and annual opt-outs from plan business. There are still many clarifications and unanswered questions we expect to be answered in future sub-regulatory guidance. We will be sure to update you as we get them.
For more comprehensive guidance, please reference: Agent Compliance Guide — Best practices in overall Medicare Compliance
2023 CMS Final Rule Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs
Over 29 million individuals receive their Medicare benefits through Medicare Advantage (MA or Part C), including plans that offer Medicare Prescription Drug Benefit (Part D) coverage.
Over 23 million individuals receive Part D coverage through standalone Part D plans.
The primary purpose of this final rule is to implement changes to the MA and Part D programs. This final rule implements changes related to marketing and communications, past performance, Star Ratings, network adequacy, medical loss ratio reporting, special requirements during disasters or public emergencies, and pharmacy price concessions. This final rule also revises regulations related to dual eligible special needs plans (D-SNPs), other special needs plans, and Medicare cost contract plans.
New CMS Call Recording Requirements CMS has new Medicare marketing rules that affect how you work as an agent and will likely mean big changes for you and your agency.
These changes include:
New requirement for third-party marketing organizations (like GoldenCare)
A new process for submitting marketing materials to CMS
A new, broader definition of “marketing” that expands the types of materials that must be submitted to CMS.
New requirements for agents to record all calls with beneficiaries
Additional Details:All calls with beneficiaries must be recorded in their entirety. You are responsible for compliance with this requirement. The requirements are effective now for plan enrollments beginning on January 1, 2023. As AEP is the start of marketing for plan year 2023 enrollments, this means that you should record all calls in their entirety beginning on October 1, 2022.
CMS Requires New Verbal Disclaimer to be Read During Telephonic Sales Calls
The disclaimer announced in the 2023 CMS Final Rule extends to telesales calls and must be read within the first minute of the call. This disclaimer now applies to all third-party CY2023 materials as well as telesales calls beginning October 1, 2022.
DISCLAIMER:
“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.”
This rule was implemented after CMS reviewed beneficiary complaints and listened to the sales organizations’ telephonic enrollments. From this, CMS determined that many beneficiaries are confused about the enrollment process as well as the plan choices available to them. This disclaimer was created to help clear up that confusion.
Although it may feel as though the disclaimer emphasizes what you do not offer, stay focused on what you can offer your prospects. Take time to consider their experience with Medicare benefits, what kind of plan would improve their experience, and work with them to figure out what plans would be best meet their medical and financial needs.
Note: It is anticipated that CMS will conduct surveillance of telesales call recordings to assess compliance during the next year, and they expect all organizations to provide a disclaimer during sales calls.
It is important to update your documents and scripts to ensure that you are incorporating the new disclaimer in time for AEP sales.
What Is Partnership?
In 2006, President Bush signed the Deficit Reduction Act of 2005, which enables states to create LTCi Partnership programs. These alliances between the states and private insurance companies encourage people who otherwise might rely on Medicaid for their LTC needs to purchase partnership-qualified policies.
Insurance companies voluntarily agree to participate in a state’s partnership program by offering LTCi policies that meet specific requirements:
The policy must be Tax-Qualified
The policy must offer inflation protection based on specific age brackets at the time of purchase
The Long-Term Care Insurance Partnership Program began in the 1980s to encourage the purchase of private long-term care insurance. It provides an alternative to spending down or transferring assets by forming a partnership between Medicaid and private long-term care insurance.
One of the main benefits of Long-Term Care Partnership plans is that they allow individuals who deplete their long-term care insurance benefits to retain a specified amount of assets and still qualify for Medicaid, provided they meet all other Medicaid eligibility requirements.
The majority of states now offer Partnership qualified policies, and require insurance professionals to comply with required Certification training prior to selling, soliciting or negotiating a long-term care insurance sale.
It is important to ensure you are compliant with your state’s Partnership Certification Training prior to taking an LTCi application!
If a Long-Term Care insurance application is taken while non-compliant, carriers will require you retake the application (re-date and re-sign) after having completed the required training.
GoldenCare’s preferred online CE provide is United Insurance Educators, Inc (UIECE). We have partnered with UIECE to offer CE Vouchers which will allow recipients to complete one CE Course, compliments of GoldenCare.
If you have any questions or need to verify compliance, call our Licensing Team at 800-842-7799!
GoldenCare’s preferred online CE provide is United Insurance Educators, Inc (UIECE). We have partnered with UIECE to offer CE Vouchers which will allow recipients to complete one CE Course, compliments of GoldenCare.