Understanding the New Medicare Marketing Guidelines

By Dwane McFerrin, Vice President, Medicare Solutions

  • Originally published July 30, 2018 , last updated August 24, 2018
  • CMS, AEP, Medicare Supplement, Medicare Advantage
Understanding the New Medicare Marketing Guidelines

Medicare Advantage continues to expand its share in the senior health market. The definition of MA benefits has been expanded, and more plans are available in more areas than ever before.

In recent years, the Centers for Medicare & Medicaid Services (CMS) has lightened the regulatory burden on carriers and agents.This year's changes to the Medicare Marketing Guidelines also reduces some of the burden. There have been some definition changes, leading to a name change. CMS has renamed the guidelines the Medicare Communication and Marketing Guidelines (MCMG).

The changes were released on July 20, and signal new opportunity for agents to connect with prospects in more ways and provide quality service to MA clients.

Reviewing and comparing the guidelines can be a time-consuming task. The compliance professionals here at Senior Market Sales developed the following summary of some MCMG changes for 2019 that represent items we felt would be material to agents marketing MA/PD Plans. However, it is not an exhaustive list and this summary is subject to change.

NOTE: All Plans/Part D sponsors are responsible for ensuring compliance with CMS’ current marketing regulations and guidance and may impose additional restrictions for subcontractors, downstream entities, and/or delegated entities, provided they do not conflict with the requirements outlined in the MCMG.

Communication and Marketing — “Communications” is a new category of materials and activities to provide information on MA/PD Plans to current and prospective enrollees.  “Marketing” is a subset of “communications” and the definition of “marketing” was updated to include only materials that are most likely to lead to a beneficiary to make an enrollment decision.  CMS review is required only for marketing materials. The difference between communication and marketing activities and materials is based on the intent and content of what is being conveyed.

Medicare Educational Events — CMS now allows agents to set up future marketing appointments, distribute business cards and contact information for beneficiaries to initiate contact, and they may include communication activities and distribution of communication materials. 

Please keep in mind that agents may not solicit/accept enrollment applications for a January 1, 2019, effective date until October 15, 2018, unless the beneficiary is eligible under another enrollment period.

Credentialing — Plans are no longer required to terminate unlicensed agents and are given the flexibility to determine level of disciplinary action against agent.  However, Plans may only pay agents/brokers who meet state licensure/appointment requirements and have completed product certification.  Plans are required to report all non-credentialed agent sales to CMS.

Business Reply Cards (BRC) — No requirement to be submitted through HPMS if no plan specific benefits are mentioned.

Restoration of the Medicare Advantage (MA) Open Enrollment Period (OEP) — From January 1 through March 31 annually and allows individuals enrolled in an MA plan, including newly MA-eligible individuals, to make a one-time election to go to another MA plan or Original Medicare. Individuals using the OEP to make a change may also add or drop Part D coverage. The MA disenrollment period (previously from Jan 1st through Feb 14th) was eliminated. It is prohibited to knowingly target or send unsolicited marketing materials to any MA enrollee or Part D enrollee during this OEP.

Limitation to the Part D Special Enrollment Period for Dual and Other LIS-Eligible Beneficiaries — Revised the SEP for dual-eligible and LIS beneficiaries from an open-ended monthly SEP to one that may be used only once per calendar quarter during the first nine months of the year. Can also be used: 1) within a certain period of time after a CMS or state-initiated enrollment; and 2) within a certain period of time after a change to an individual’s LIS or Medicaid status. It is not available to those identified as “At Risk” or “Potentially at Risk” for prescription drug abuse under drug management programs.

Taken as a whole, these changes can be viewed as a significant improvement for agents serving MA clients. The upcoming AEP is an ideal time to start or expand your Medicare Advantage offering.

Pay attention to the new terms, or re-definition of terms. “Communications” is a new term, and “Marketing” has been re-defined as a subset of Communications, and means activities and materials that are most likely to draw attention to and influence a beneficiary’s decision-making process and lead to a MA/PD enrollment decision.

Marketing requires CMS review. Communications does not.  An example of “Communications” would be activities/materials that promote awareness of MA plans in general, and your agency offering that type of plan. While a brochure or social media ad that provides specific details about a plan’s benefits, cost sharing or ranking standards would be considered “Marketing.”  

The rules regarding educational events are worth noting. It’s now reasonable to include and distribute items defined as “Communication” during educational events. For example, that means you may offer business cards or agency information at educational events, without having to be asked by a contact.

The rules for communicating by mail with business replay cards have been relaxed, as long as plan specifics aren’t included.

SMS Marketing Consultants can help you navigate the Medicare market and spot opportunities to grow your business. Call to learn more about these changes to the MCMG, or to start offering MA plans to your clients. Call 1.877.645.0147.

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