Each year the Centers for Medicare & Medicaid Services (CMS) reviews their policies for Medicare Advantage and Part D, proposes changes, and issues a final ruling detailing what is changing for the coming plan year.
The recently released final rule for contract year 2024 outlines key changes that impacts sales processes. It is important to understand these changes; failure to comply with them can lead to significant consequences for your business. Changes are effective September 30, 2023.
Here is what you need to know:
Updated TPMO disclaimer. When promoting Medicare Advantage or Part D plans, you will need to add the updated TPMO disclaimer on all your marketing materials like websites, brochures, or phone calls. This disclaimer should be specific to the service area of the person you’re talking to or advertising to. You should also make sure to include it within the first minute of any audio presentation or call.
Updated 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 which are plans offered by [number of MA organizations]. Please contact Medicare.gov, 1-800-MEDICARE (633-4227), or your local State Health Insurance Program to get information on all your options.”
Changes to call recording requirements. Call recordings are now limited to those solely related to sales, marketing, and enrollment, as opposed to recording all calls. Call recording includes Zoom, Facetime, Skype, or other technology-based platforms and applies only to the audio portion of the call.
Prohibits the use of the Medicare name, logo, or watermark. Prohibits the use of the Medicare name, CMS logo, products or information issued by the Federal Government, including the Medicare card, in a misleading manner. CMS acknowledges that reasons may exist to use the Medicare card image, which they will permit with authorization.
Prohibits using unsubstantiated statements. CMS restricts the use of superlatives by prohibiting them unless substantiated supporting data is referenced in the materials. This data must be current and from either the current or prior contract year.
Prohibits advertising benefits not available in the plan area. To reduce misleading marketing, CMS specifies that MA and Part D plans may not engage in marketing that advertises benefits not available to the beneficiaries in the service area where the marketing appears, unless it is unavoidable in a local market.
Prohibits marketing unless the names of MA organization or Part D sponsor being advertised are clearly displayed. This new rule stipulates that MA organizations and Part D sponsors are no longer allowed to promote any products, plans, benefits, or costs unless they clearly disclose their name or marketing name(s) in the promotional material.
Prohibits the marketing of “savings” not realized. MA and Part D plans cannot tell potential enrollees how much they could save by comparing their costs to those of people who don’t have insurance or who have not paid their medical bills. They also cannot use costs that Medicare beneficiaries haven’t had to pay.
Prohibits distribution of Scope of Appointment (SOA) or scheduling future sales meeting at education events. The new rule reinstates the prohibition on accepting SOA cards or the collection of beneficiary contact information at educational events.
Clarify door-to-door solicitation. Visiting a Medicare beneficiary at their home is considered unsolicited door-to-door contact unless the beneficiary had agreed to an appointment and the date and time were set in advance.
Requirement for an annual opt-out for plan business. Each MA and Part D plan is required to provide opt-out information to all its enrollees, regardless of plan intention to contact, at least annually in writing, instead of just one time. This ensures beneficiaries are reminded that they may decide at any time to opt out of being contacted by their MA organization/Part D sponsor about plan business.
Separation of educational events from sales events. Marketing events are prohibited from taking place within 12 hours of an educational event that is in the same location. This will give beneficiaries sufficient time to consider the impartial and factual information provided at the educational event.
Requires 48 hours between the Scope of Appointment (SOA) and a meeting with beneficiary. The 48-hour rule for the SOA has been reinstated, with a few exceptions. For instance, if a beneficiary is nearing the end of a valid enrollment period, such as the Annual Enrollment Period, Open Enrollment Period, Special Enrollment Period, or Initial Coverage Election Period, they may be exempt from this rule. Additionally, walk-in meetings that are initiated by the beneficiary and are not scheduled in advance are also exceptions to this rule.
Limits Scope of Appointments (SOA) and Business Reply Cards to a 12-month timeframe. SOA and business reply cards now have a clear written time limit of 12 months, starting from the beneficiary’s signature date or their request for additional information. If the original SOA or permission to contact has expired, a new one will be required.
“Effect on current coverage” to be added to the pre-enrollment checklist (PECL) and review of PECL. As part of the enrollment process, agents must clearly communicate the impact of a client’s enrollment decision on their existing coverage.
Submission of marketing materials. TPMOs that develop marketing materials for more than one MA or Part D plan must obtain prior approval from each plan for whom the materials were developed and submit those marketing materials directly to CMS for review and approval.
Requires MA organizations and Part D sponsors to have a monitoring and oversight plan and report agent non-compliance to CMS. At a minimum, the oversight plan should include checking complaints made by people within the organization and complaints made to 1-800-MEDICARE (633-4227). It should also include listening to recordings of past sales, marketing, and enrollment calls, as well as monitoring live ones.
This is not an exhaustive list of all the changes in the final rule for Contract Year 2024. As an agent, it is important to read and understand the full details to ensure that your sales processes are compliant.
Questions? Reach out to Broker Concierge Support at govt_broker_services@BlueKC.com or your Broker Development and Engagement Manager.