Stay Compliant: Essential Medicare Advantage Marketing Rules for 2024
Medicare Compliance: A Guide to Marketing Medicare Within the Rules
Marketing Medicare plans can be challenging. With the growing competition in Medicare Advantage sales and the fast-paced enrollment season, it’s crucial to maintain compliance. Avoiding compliance missteps ensures your success and keeps your business on track.
Below is a comprehensive guide to navigating Medicare Advantage compliance and following the various rules governing the sale and marketing of Medicare products. This blog has been written by Medicare Marketing Agency for Insurance Brokers.
Understanding the CMS Medicare Marketing Guidelines
The starting point for any Medicare Advantage compliance strategy is familiarizing yourself with the guidelines from the Centers for Medicare & Medicaid Services (CMS). CMS enforces the Medicare Communications and Marketing Guidelines (MCMG), which apply to Medicare Advantage and Part D sponsors. These sponsors must monitor partners, including lead providers and generators, to ensure compliance.
Key aspects of CMS guidelines include:
Prohibited Activities: Activities like misleading messaging and providing meals at events are strictly prohibited.
Disclosure Requirements: Marketing materials must include specific disclosures. This list was expanded recently to include new, specific requirements for Medicare marketing affiliates, lead generators, and sales agents.
Defined Enrollment Periods: Compliance includes adhering to strict enrollment windows, which are outlined below.
Critical Medicare Marketing Dates
Each year, Medicare’s Annual Enrollment Period (AEP) runs from October 15 to December 7. This period allows Medicare beneficiaries to make important changes to their coverage, such as:
Switching from an Original Medicare plan (Part A and Part B) to a Medicare Advantage plan (Part C).
Changing from one Medicare Advantage plan to another.
Switching from one Prescription Drug plan to another, or enrolling in a Medicare Advantage Prescription Drug plan.
Adding a new Prescription Drug plan if not already enrolled.
Following the AEP, the Medicare Advantage Open Enrollment Period (OEP) runs from January 1 to March 31. During this window, only those currently enrolled in a Medicare Advantage plan can adjust their coverage for the upcoming year. Note that October 1 is also an important date—marketing for the upcoming year’s Medicare plans cannot start until this day per CMS rules.
Permission to Contact (PTC)
PTC is critical in ensuring Medicare beneficiaries’ contact preferences are honored in marketing. Insurance agents and Medicare providers must obtain explicit permission from beneficiaries before contacting them with marketing communications, helping to protect against unsolicited outreach.
Key PTC Guidelines
When Required: PTC is needed to discuss specific Medicare plans with beneficiaries.
Allowable without PTC: Agents can send unsolicited emails marketing their services (not plans) as long as emails meet CMS guidelines and offer an opt-out option.
Additional PTC Requirements: Agents can contact individuals who filled out a form or requested a call, but other communication channels, like text messaging or social media, require PTC.
Scope of Appointment (SOA)
Once PTC is obtained, agents can proceed with a Scope of Appointment (SOA) agreement. CMS mandates that agents document the types of products they’ll discuss in sales meetings, helping to ensure transparency.
Why SOA is Essential: SOA documentation provides clarity on the topics to be covered in a meeting, such as Medicare Advantage, Prescription Drug Plans, and other related insurance products. This prevents discussions from going beyond the agreed-upon topics.
Compliance Requirements for TPMOs
In 2022, CMS introduced specific compliance requirements for third-party marketing organizations (TPMOs), covering agents and brokers involved in Medicare-related lead generation and enrollment.
Key TPMO Compliance Points
Disclaimers in Marketing Materials: TPMOs must include disclaimers in all materials, including websites, print, and TV ads.
Disclosure to Prospects: Lead generators must inform beneficiaries if they’ll be contacted by a licensed insurance agent.
Recording Requirements: TPMOs must record all calls (including video calls) that discuss Medicare benefits. These records help ensure transparency and regulatory compliance.
CMS Rule Updates for 2024
To further protect beneficiaries, CMS has introduced new guidelines for the 2024 contract year. The changes, effective September 30, 2023, include:
Ad Restrictions: Ads cannot use the Medicare logo misleadingly or use superlative claims (like "best") without supporting data from the current or previous year.
Opt-Out Notifications: Medicare Advantage and Part D plans must now notify enrollees of their right to opt out of marketing calls annually.
New SOA Protocols: SOA cards may no longer be collected at educational events, and agents must wait 48 hours after completing an SOA before meeting with a beneficiary.
Event Timing Rules: Marketing events cannot occur within 12 hours of an educational event at the same location.
Clear Explanation of Coverage Impacts: Agents must explain how a beneficiary’s enrollment decision may impact their current coverage.
Oversight Reporting: Plans must report any agent or broker noncompliance issues to CMS and monitor these activities closely.
Beyond CMS Compliance: TCPA Regulations in Medicare Marketing
In addition to CMS guidelines, marketers need to be aware of the Telephone Consumer Protection Act (TCPA) requirements during Medicare enrollment periods. Under the TCPA:
Written Consent is required for marketing calls to cell phones using automated or prerecorded voice technology.
Residential Landlines: Prerecorded calls to residential landlines on the Do Not Call (DNC) list also require written consent unless there is an existing business relationship or they are responding to an inquiry.
TRACED Act: Limits apply, such as three marketing calls per month for non-healthcare calls and three per week for healthcare-related calls to residential landlines.
Methods for Capturing Consent
Documenting consent is as important as obtaining it. Here are ways to capture and record it:
Online Forms: Follow best practices in formatting, and use trusted tools like TrustedForm for independent consent verification.
Contract Terms: Retain signed terms to document consent agreements.
Recorded Calls: Limit recordings to informational purposes only.
Text Messages: Adhere to SMS compliance protocols to capture and store consent records.
In summary, adhering to Medicare marketing rules for Medicare Lead Generation means understanding CMS and TCPA regulations and committing to proper consent documentation.
