On April 5, 2023, CMS finalized its 2024 Final Rule. The new rule, which takes effect on September 30, 2023, outlines new regulations that focus on marketing and advertising practices to help reduce fraud and abuse.
These new regulations will impact agents and TPMOs in multiple ways at fall AEP. There are a few things you need to know to stay compliant.
Changes to Educational and Marketing Event Rules
- The new rule restricts the distribution of SOAs and appointment setting at Medicare educational events. Agents are still allowed to have permission-to-contact cards, BRCs and business cards present at the event for the attendees to electively pick up.
- A marketing event must not occur within 12 hours of an educational event at the same location.
Updates on SOAs and BRCs
- There must be a 48-hour window between completing an SOA and a meeting with a beneficiary. Some exceptions are allowed, including unscheduled walk-ins, transportation issues with the client and when a beneficiary is approaching the end of a valid enrollment period.
- SOAs and BRCs will now be valid for a 12-month period from the date of signature. Agents must keep track of the date they receive them. After 12 months, you will need to acquire renewed permission to discuss plan details.
- CMS confirmed it still prohibits door-to-door contact without a prior appointment after collecting a BRC or SOA.
Use of the Medicare Name and Logo
In response to complaints, CMS is restricting the use of the Medicare name and logo, including the example copy of the Medicare card. This is due to concern that beneficiaries may be misled into thinking they are dealing with the federal government. The ruling states CMS will hold MA and Part D sponsors accountable for the actions of their downstream entities – further clarification is forthcoming. It is anticipated that carriers will require agents to remove “Medicare” from their business name, logo, or URL and only use the word “Medicare” to describe product types, such as Medicare Advantage and Medicare Supplement.
Modifications to the TPMO Disclaimer
Disclaimers must now include the State Health Insurance Programs (SHIP) as an option for beneficiaries to obtain additional help and information. The disclaimer must also state the number of organizations the TPMO represents as well as the number of plans it has. Agents must use disclaimers within the first minute of a phone call and on all their marketing materials – both print and digital. The disclaimer must appear on websites, and agents must provide the disclaimer when communicating through email and online chat. It must be specific to the beneficiary’s service area.
The required disclaimer for TPMOs that sell all MA and Part D plans within a service area is now:
“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.”
Marketing Requirements and Restrictions
- Marketing materials should be free from all superlatives such as “best” and “most,” unless the material provides documentation to support the statement. Supporting data must be from the current or previous year.
- When marketing any plan-specific benefits or cost sharing, agents must now submit to all carriers for approval, and then to CMS for final approval.
- Keep your creations generic and use Carrier/ CMS approved Marketing Materials.
- When Marketing plan benefits, pieces must target only beneficiaries within the plan’s service area, unless this is unavoidable due to the scope of local or regional media. For example, an ad in a newspaper may reach some beneficiaries who are outside the plan’s service area.
Call Recording Clarifications
- CMS clarified that agents only need to record marketing, sales, and enrollment calls. They do not need to record the follow-up calls they use to check in after sales or calls to set appointments.
- CMS also clarified that the recording rule applies to virtual calls, such as video conferencing. Agents only need to record the audio portion of the call.
Enrollment Related Updates
- Whenever a client makes an enrollment decision, the agent must explain how this decision will impact the client’s current coverage.
- CMS is developing a standardized list of questions agents must ask before enrolling a beneficiary in a plan.
CMS will be releasing additional guidance on both of these requirements.
It’s important to stay informed and current on all the upcoming changes. Our team at Western Asset Protection is here to help. Contact us today.