NEW CMS RULE CHANGES

Below is a summary of some of the new CMS rule changes. As we get closer to AEP, we will be sharing any additional information from CMS and/or insurance carrier partners.

• Marketing materials cannot advertise benefits in areas where they are not available.
• Marketing materials cannot advertise beneficiary savings based on comparisons to an uninsured individual.
• Marketing for MAPD and PDPs cannot generalize savings when the actual savings are specific to the individual.
• Prohibits the use of superlatives in most marketing unless documentation is provided to support the statement based on data from the current or prior year is included in the marketing piece.
• Plans represented by a marketing material must be listed on the material.

Medicare Name, Marks, & Logo

• CMS finalized and strengthened rules regarding the use of the word Medicare and other federally owned brand marks.
• CMS will require prior authorization to use certain marks or assets, including the image of the Medicare Card. More to follow as additional guidance is released.
• It will be important to ensure that a marketing design does not confuse a beneficiary into thinking they are dealing with Medicare. This includes, but is not limited to, the use of red/white/blue colors, using the Medicare logo, using a picture of a Medicare ID Card or use of the Department of Health & Human Services (HHS) logo.

• Agents must obtain an SOA no less than 48 hours prior to presenting and enrolling a beneficiary into a plan. 
• There are exceptions to the 48-hour rule: 
  • The 48-rule is waived if a beneficiary is in the last four days of their valid enrollment period. 
  • The beneficiary is a walk-in appointment. 
  • The beneficiary faces transportation or access challenges. 
• SOAs are valid for a 12-month time frame from the beneficiary’s signature date or their request for more information.

• NO sales event may take place within 12 hours of an educational event in the same location – which includes the same room/venue, building, or adjacent buildings.
• Agents can no longer collect SOAs or schedule a future appointment with beneficiaries at educational events, however, agents may obtain an optional Business Reply Card (Permission to Call Form) at an Educational Event.

• CMS will issue additional guidelines on a pre-enrollment checklist that will include new required discussion items. 
• When a client makes an enrollment decision, agents must explain the affect of their enrollment choice against their current coverage.

• The required disclaimer now applies to all third-party marketing organizations (TPMO), including those offering only one plan or all plans in an area. Agents must add State Health Insurance Programs (SHIPs) to the list of resources available to help a beneficiary. 
• TPMOs must disclose the number of carriers and number of plans you represent in the required disclaimer on all marketing materials. 

Sample NEW Disclaimer 

“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 of your options.”

• CMS is amending the requirement to record ALL calls. Beginning September 30, 2023, only sales and enrollment calls will need to be recorded. 
• CMS further clarifies that virtual meetings, such as Zoom or FaceTime, are considered the same as a call and therefore the audio from those communications must be recorded if applicable.

• CMS rule changes clarify that permission to call is not the same as permission to show unannounced at a beneficiary’s home. 
• Door-to-door marketing of MAPD and PDP products remains illegal per CMS marketing rules and regulations. 
• Collecting a Business Reply Card is not a substitute for permission to knock on a beneficiary’s door without having a scheduled appointment with the beneficiary at that specific time.