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2024 CMS Regulations Compliance: Medicare Advantage Advertising

Agents must stay abreast of the yearly changes to the Center for Medicare and Medicaid Services’ (CMS) regulations. For the coming year, 2024, there are new regulations to observe in the realm of advertising and marketing.

For Third Party Marketing

• TPOs submit all marketing materials for Medicare Advantage and Prescription Drug Plans, or Part D plans to CMS before use.

• Use only Marketing materials  approved by CMS.

• Online videos or television advertisements used in marketing are subject to a 45-day review period by CMS.

• Allow  carriers to preview and approve materials  before submitting to CMS’ Health Plan Management System (HPMS).

These new guidelines mean that even advertisements that do not mention any specific plans by name are considered marketing materials and must be submitted to the CMS HPMS for approval prior to their use.

What Agents Need to Know

Use either carrier-created advertising materials or create communications rather than marketing materials. Communications are defined as ads that do not have intent or content.   These are compliant with CMS, state, and federal guidelines. Because communications are not marketing materials, they do not need to be submitted to CMS prior to use.

CMS will withdraw any marketing materials that are no longer in compliance.

Agent-created multi-plan marketing materials will need to be submitted separately to compliance. Send these to the carriers listed for review and possible approval. After approval,  file the materials with CMS’ HPMS. The insurance carriers will conduct their own reviews. All submitted materials will need a Standard Material ID on them (SMID), and agents and their agencies are responsible for creating and tracking those IDs.

Disclaimer Requirement

Include an additional disclaimer on all marketing materials.  This is required for the 2024 contract year Agents who do not sell for all carriers in a service area must include the following on their materials on and after September 30:

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.

For agents who do sell for all of the insurance carriers in a service area, the following disclaimer is required:

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.

These disclaimers must be written on printed marketing materials, visible on email communications, and visible in any television or internet ads, as well as displayed on websites.

FAQs:

Q: Are all marketing materials impacted?

A: Yes. All partners who create or use multiplan marketing materials must submit their materials to the compliance email address. Use the carrier created ad materials.

Q: Can I market new plans prior to October 1st?

A: No, agents cannot market new plans for the coming contract year prior to October 1st.

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Connecticut Medicare Demographics

Agents need to be up to date on the latest trends for all aspects of marketing, educating, and enrolling beneficiaries in Medicare insurance policies. Medicare Advantage, Medigap, and Medicare Part D are all provided by private carriers who are accountable to the regulations from the Center for Medicare and Medicaid Services, and these regulations change yearly. In addition to keeping up with changes, it is helpful for an agent to know the demographics of their area. Understanding Connecticut Medicare demographics helps best serve clientele.

At last count, when the survey was conducted in 2021, over 700,000 people in Connecticut were enrolled in Medicare. That is a large number of people, particularly for such a small state; Medicare beneficiaries make up 19% of the state population. Of those 700,000 people, 363,399 of them enrolled in Original Medicare. In other words, 52% of the eligible population in Connecticut is enrolled only in Medicare Parts A and B. Medicare Advantage or other health insurance policies make up the remaining 48%. For agents, it may be helpful to think about these numbers like so: Over half of the eligible people in the state may need your help to choose an additional Medicare Advantage or other plan.

Understanding the Connecticut Medicare Demographics

However, Connecticut is among the states with the highest percentage of eligible people enrolled in a Medicare Advantage insurance plan. Part of this has to do with Connecticut having some of the strongest Medigap consumer protection laws in the nation. It also has to do with the widespread availability of Medicare Advantage plans. In 2023, all of the counties in Connecticut had access to 44 or more Medicare Advantage plans. Some counties had access to as many as 58 options.

In addition, there are 13 different insurers who offer Medigap plans in Connecticut. The state requires that all of those plans are guaranteed-issue and community-rated at all times. As for Medicare Part D or prescription drug coverage, there were 24 stand-alone plans available in 2023. Premiums tend to range from $7 a month to $124 a month, making them accessible to a wide-range of people on varied incomes. This is likely a factor in why over 40% of Connecticut Medicare beneficiaries have stand-alone prescription drug coverage.

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Travel Benefits with Medicare Advantage

If there’s one thing that many people look forward to about retirement age, it is the opportunity to do things that their work lives made it difficult to do previously. For many, this means travel. As people age, however, their medical needs often become more complex.  This means that it is necessary to think about medical benefits and how that coverage will be affected by travel. Here’s how travel benefits with Medicare Advantage can be affected by these situations:

Travel Inside the United States

Original Medicare covers beneficiaries in all 50 states, and the United States’ territories such as Guam, Puerto Rico, American Samoa, and the Virgin Islands. Over 93% of doctors and hospitals in the U.S. and its surrounding territories participate in the Medicare program, and coverage is almost universal within the country because of it.

For Medicare Advantage plans, however, coverage is far more dependent on the insurance plan and carrier. There are some plans that do not cover any medical or healthcare services outside of their area. Some plans will cover services outside of the designated area and network, but with significantly higher co-pays and fees. There are also restrictions like prior-authorization to work around with some plans. However, the Medicare Advantage plans are required to cover emergency care anywhere in the United States.

Travel Outside of the United States

There is far less coverage for beneficiaries if they are traveling outside of the country and its territories. For both Original Medicare and Medicare Advantage, there are very limited circumstances in which they will cover medical and healthcare services:

• Medical services received in Canada while beneficiary is traveling between the continental U.S. and Alaska are covered.

• Beneficiaries who receive care on a cruise ship will be covered if the ship is in U.S. territorial waters. That means within six hours of a United States port.

• In very few situations, both Original Medicare and Medicare Advantage will cover hospital services if the hospital at which they were received was closer than a hospital in the United States. The most likely situation in which this could happen would be if the beneficiary is at the border of Canada or Mexico.

For beneficiaries about to embark on any journeys inside or outside of the United States, it is important to be aware of what their insurance will cover and what will cost them out of pocket.

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Travel Benefits with Medicare Advantage is only one small piece of the picture.

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How to disenroll from Medicare Part B

In this post, we will go over how to disenroll from Medicare Part B.  Although it is a rare occurrence, you can terminate your Medicare Part B (Medical Insurance). Although you may need to have a However, you may need to have a personal interview with Social Security to go over the risks of dropping coverage.  They will also be able to help make sure you have everything you need to process your request.

If you  want help terminating your Medicare Part B or to schedule a personal interview, you can contact Social Security either at 1-800-772-1213 (TTY: 1-800-325-0778) or in person.  Click the following link to  find your local  Social Security office.

To cancel Medicare Part B, you will need to download and print Form CMS 1763.  Once you have the form, do not fill it out until you have your interview with Social Security.  They provide instructions on how to fill it out.  If you already have your Medicare card, you’ll need to return it.  You can do this either during the in-person interview or by mail once you complete the phone interview.

Some risks to disenrolling from Medicare Part B:

If you do not have health coverage, you could become injured or ill and be stuck paying for all your medical services out-of-pocket.

Any time you go without creditable coverage, you have a coverage gap and will pay a late enrollment penalty unless you have a SEP (special election period) once you do sign up.  You also need to wait until the next General Enrollment Period to get coverage.  This period runs from January 1 through March 31st annually.

Click here to learn more about the risks of late enrollment in Part B

Any month that you are enrolled in Medicare Part B, you will pay a premium.  Once you disenroll from Part B, it will end the first of the following month after you file the request. If you decide to keep Part A, you will receive a new Medicare card showing Part A only.

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Life Insurance vs. Annuity

Which is Right For You? Although both life insurance and annuities are very different, they can both play a role in providing financially for individuals and families as they age and retire. Here’s the quick version:

Life Insurance

Life insurance is an insurance policy that pays out to the chosen benefactor at your death. It can provide income for loved ones and cover final expenses such as medical bills, funeral costs, and even help clear debts. There are two common types of life insurance: term life insurance and whole life insurance. Term life insurance is more affordable, with lower premiums, and has an expiration date, which is typically 10, 15, 20, or 25 years after enrolling. Whole life insurance is just that, for the person’s whole life until death.

Annuity

Annuities are also a type of life insurance, but with a different structure. Instead of a death benefit, an annuity provides payouts over your lifetime. Because of this, it provides guaranteed lifetime income. There are also two types of annuities: immediate annuities and deferred annuities. Immediate annuities are contracts purchased with a one time payment to the insurance company and provide payments to you within the first year of purchase. Deferred annuities provide payouts that start at a future date instead of within the first year of purchase.

Which is Best For Me?

That depends on your situation. You’ll need to ask yourself the following questions:

• Is a steady income in retirement something I want or need? If so, an annuity may be right for you.

• Do you have loved ones that need to be provided for after you die? Life insurance is designed to do that.

• Or, do you want to provide both forms of financial support – steady income in your later years and a death benefit for your loved ones? If so, it may be best for your situation to include both life insurance and an annuity, either immediate or deferred, in your financial planning.

Talking to a licensed financial advisor would be a good next step for anyone considering either life insurance, an annuity, or even both.

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Inflation Reduction Act and Medicare Changes

This post will go over the Inflation Reduction Act and Medicare changes.  The goal of the Inflation Reduction Act is to provide some financial relief for Medicare beneficiaries by making adjustments to the Medicare program.  The new prescription law improves the Medicare program by expanding benefits, lowering drug costs and keeping the drug plan premiums stable.

Inflation Reduction Act and Improvements to Medicare Part D:

Medicare beneficiaries will have access to lower prescription drug costs as well as a redesigned prescription drug program. This new program includes benefits such as:

A $35 monthly co-pay for covered insulin prescriptions.

An annual cap of $2,000 on out-of-pocket costs, starting in 2025.

No cost for recommended adult vaccines.

Starting in 2024 the LIS/Extra Help program under Part D will be expanded to include 150% of the federal poverty level.

Inflation Reduction Act and Price negotiation of Medicare prescription drugs:

This is an important change.  It gives Medicare the power to negotiate the cost of prescription drugs directly with the manufacturers.  This will lead to lower costs on some of the most expensive, brand-name Medicare Part B and Part D drugs.  Because of this change, more people will be able to afford the life saving treatments they need.

The inflation reduction act requires drug companies that raise their prices faster than the rate of inflation to pay Medicare a rebate.  Because of this, drug manufacturers will be discouraged from charging Medicare beneficiaries ridiculous price increases.

Inflation Reduction Act and Changes to Medicare Part B:

Changes in the Medicare Part B program will improve access to high quality, affordable biosimilars for people with Medicare as well as impose a $35/month cost-sharing cap on insulin used in durable medical equipment pumps.

The Inflation Reduction Act makes Medicare stronger for current and future enrollees. It makes health care more accessible, equitable, and affordable by lowering what Medicare spends for prescription drugs and limiting increases in prices.

Find the answers to some FAQs on the Medicare drug price negotiation

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Prepare for Medicare AEP

It may not feel like it now, but summer is almost over. Before you know it, Fall will be here.  And, with it the Annual Enrollment Period (AEP) for Medicare and Medicare Advantage insurance plans. Now is the time to prepare for Medicare AEP.

The AEP runs from October 15th through December 7th. This is the time when beneficiaries can choose to re-enroll in their existing plan, switch from Original Medicare to Medicare Advantage, add a Medicare Part D or prescription drug coverage plan.  Or opt to stay with Original Medicare and purchase a Medigap policy. Comparing plans can save beneficiaries significant money in premiums as well as make sure that their basic needs for their changing health status are covered. According to a survey conducted by Deft Research, over 44% of seniors shopped around during the Annual Enrollment Period of 2020. Whatever the changes will be, here are five ways you can start getting ready to make informed choices for your healthcare and medical insurance needs:

Read your ANOC

An ANOC is a Plan Annual Notice of Change, and insurance carriers are required to send them out to their beneficiaries each year. Its purpose is to inform members of a plan as to what changes will be coming to that plan in the following year. Some possible changes might be raising the premium, your healthcare team no longer being in-network, or adding or discontinuing extras like dental or vision. There have even been cases when an insurance plan was completely gotten rid of, and those beneficiaries had to choose a new one regardless of whether they had planned to switch. The ANOC will have all the information you need to know about what will be different next year.  Begin preparing for Medicare AEP by understanding what you currently have.

Stay aware of the timeline

The timeline for Annual Enrollment goes like this: on October 1st, new plans are released.  This gives people time to peruse and compare before the enrollment starts on October 15th. December 7th is the deadline for making a choice in coverage. The more research you do, the more informed you’ll be.

Work with a broker to Prepare for Medicare AEP

Brokers work with multiple insurance companies.  They are uniquely suited to help you compare and contrast the ins and outs of  plans. Doing this process with a broker may help you save significant time on research.  They are in the business of knowing all the details you would be looking for.  A reputable broker is a must to prepare for Medicare AEP.

Make a list of your important questions

You have to know what you need and want in a healthcare plan before making a choice – otherwise you may end up with a plan that doesn’t suit your needs at all. Some questions to ask might be: Is my doctor in-network? Is this prescription that I need to take covered? Will there be vision and dental coverage or is that extra?  Make note of this when preparing for Medicare AEP.

Review the logistics of enrollment

There are several options for enrolling in a new plan: you can meet with an insurance representative face to face, fill in and mail all the paperwork yourself, or enroll directly with a broker who will walk you through the process. And, although it’s normal to be hesitant to make any big changes in healthcare coverage, remember that, whichever plan you choose, it’s only for the next twelve months. Annual Enrollment Period will be back next year.

Licensed Agents – Prepare for Medicare AEP

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Devoted First Look 2024

The Devoted first look 2024 includes an expansion in 12 of the 13 markets Devoted is available in!  Devoted provides an excellent team of 100% U.S.-based support for both agents and Members.

Devoted Agent support statistics:

Nearly 96% of agent calls are answered within 30 seconds.  This is very important when you do not have time to waste.  Over 90% of all issues are resolved on the first call.  The average case resolution is 1.4 days.  Devoted provides bilingual support with expanded weekend hours during AEP.

The Member guides:

On average 92.5% of all member calls are answered in 30 seconds, although wait times may vary somewhat during some enrollment periods.  Almost 92% of issues are resolved on the first call this helps cut down on member frustration.  During the busy seasons of both AEP and OEP, Devoted provides extended weekend hours to be sure all member’s questions are answered.

General information about the 4 plan groups of the Devoted Plans for 2024:

HMO and PPO Giveback Plans –

These plans provide high Part B giveback values.  This is offset by less rich medical benefits as well as fewer supplemental benefits as compared to other Devoted plans.  However, all giveback plans provide a dental benefit.

$0 HMO ands PPO Plans –

These plans are Devoted’s anchor product lines. They provide an equal balance between medical and supplemental benefits.  Every $0 PPO plan, except in Chicago, is now a passive design with equal in and out of network cost sharing on most benefits.  Please note; there are some market exclusions.

Premium HMO and PPO Plans –

These plans are a great option for members who want strong supplemental benefits.  All premium products are no-cost to individuals who receive 100% LIS(Extra Help).

DSNP and CSNP HMO Plans –

All SNP plans provide members with a Food & Home card as well as comprehensive dental coverage. In the states of AL, CO, FL, NC, OH, both Dual and partial D-SNP products are available.
Additionally, Devoted has renewed four C-SNP products in Arizona and Tennessee.

To view plan details by state, just click here

Download the First Look for all markets, click here

Comparing Life Insurance Products

One of the most common issues that faces people as they age is this question: how can I provide for them after I am gone? The answer for many has historically been by purchasing a life insurance policy.   For many beneficiaries as they age, they take comfort in the knowledge that their families will receive a sum of money to cover things like funeral costs, any outstanding debts, and even life essentials like groceries while they are mourning. Agents need to be well versed in all the different options for life insurance in order to present their clients with a cohesive picture of their options.

Much of the time, people think of life insurance as two-fold: people are either able to purchase term life insurance or whole life (permanent) insurance. However, there are three different options for the type of policy that is available. The following presents a comparison of these three types: fully underwritten, simplified, and guaranteed issue life insurance policies. Each one has their benefits and drawbacks.

What are the Three Types?

Fully Underwritten – Comparing Life Insurance Products

Fully underwritten policies are typically for term life insurance, meaning that coverage is for a certain time frame, such as ten years, and then the beneficiary has to reinstate the coverage when that time is up. This is a policy in which the beneficiary’s medical history is completely disclosed, and most often requires a visit from a doctor, nurse, or other healthcare professional in order to have the application accepted. The approval process for fully underwritten policies is the longest; it can take up to several weeks to get approved. However, there is no specified maximum coverage amount. These policies are recommended for individuals in good health.   They have no complex medical history.

Simplified Issue – Comparing Life Insurance Products

Simplified issue policies are also typically for term life insurance. The largest difference in the application process between simplified issue and fully underwritten is that the simplified issue application has far less medical history disclosure required. There is no visit or exam necessary by the medical professional, and, as a result, the premiums are often higher than fully underwritten policies. Approval of applications is quicker because of this, as well, with approvals in several hours to several days. The maximum amount of coverage differs by carrier, but is typically up to a million dollars in coverage.

Guaranteed Issue – Comparing Life Insurance Products

Guaranteed issue life insurance policies are for whole life, or permanent, policies. These are the most expensive premiums by far.  No medical questions.   (Hence the “guaranteed” part.) Approvals can come within a few hours. Because of the guaranteed aspect of the policy, the coverage is usually limited to between $25,000 and $50,000 per policy. These policies work best for people with a complex medical history.  These individuals may not receive coverage otherwise.

Knowing the basics of which situations require which policies can help agents successfully enroll more clients and maintain more working relationships.

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Comparing Life Insurance Products isn’t all we offer.

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Medicare and working after 65

As people approach the age of 65, many consider retiring and accessing their Medicare benefits. However, a growing number of individuals are choosing to continue working after turning 65.

Navigating Medicare and working after 65 requires an understanding of how these systems interact. By exploring your options, enrolling during the appropriate periods, and considering your retirement plans, you can make informed decisions that optimize your healthcare coverage and financial security. It is also be a good idea to consult with a licensed Medicare agent as well as a financial advisor to be sure you make the best choices for your unique situation.

Medicare Eligibility:

Most people become eligible for Medicare at age 65. If they or a spouse have worked and paid Medicare taxes for at least 40 quarters/ten years, they usually qualify for premium-free Part A.  Enrollment in Part B has a premium for most people. 

Here are the 4 parts of Medicare and what they cover:

1. Part A: Is Hospital insurance and it covers inpatient hospital stays, skilled nursing facilities, hospice care, and some home health services.
2. Part B: This coverage is called Medical insurance and it provides coverage for doctor visits, preventative care, outpatient services, and medical equipment.
3. Part C: Not everyone needs to have Medicare Part C.  This is another name for a Medicare Advantage plan.  These plans are offered by private health insurance companies and take the place of Medicare Part A & Part B coverage (although you still have to pay the Part B premium even with a Part C plan).  In most cases, they include Part D prescription drug coverage.
4. Part D: This is prescription drug coverage that helps pay for your medications.  These plans are offered by private insurance companies.

Working After 65:

Many seniors choose to work past 65 for various reasons.  These reasons may include; financial security, personal fulfillment, and maintaining social connections. If you continue working after 65, consider the following:

Employer Coverage vs. Medicare:

If you have health coverage through your employer or your spouse’s employer, you can delay Part B enrollment without facing penalties. You should look at the coverage and cost of each option before you make a decision.  This is a perfect time to consult a Medicare agent so they can go over both plans and help you make the best choice.  However, if your employer has less than 20 employees, Medicare becomes your primary coverage.  This means you should enroll in both Part A and Part B to avoid potential late enrollment penalties.

Enrolling in Medicare While Working:

If you want to access Medicare benefits while working, make sure you sign up during your IEP or Initial Enrollment Period. The IEP begins three months before your 65th birthday and ends three months after your 65th birthday.  Just be sure you understand how your Medicare coverage works with your employer plan if you have both.  You may drop employer coverage and to join a Medicare plan.  If you choose this option, you will need additional coverage such as a Medicare Advantage plan or a Medicare Supplement plan and a Medicare Part D plan.

No matter which plan you choose, be sure you have Creditable prescription drug coverage.  If you do not, you can end up with a life-long penalty for late enrollment once you decide to purchase a Part D plan.

Medicare and Part-Time Work:

Even if you work part-time, you may be eligible for Medicare benefits. The rules for Medicare and employer coverage will vary.  It all depends on your situation which includes the size of your employer.  It is best to check with your employer’s HR department and your Medicare agent to see what your options are.

Click here for more information on working past 65

Medicare and Retirement Plans:

Working after 65 can impact your retirement plans, especially if you have retirement accounts like a 401(k) or an Individual Retirement Account (IRA).  Check with your financial advisor for contribution limits and rules.  You should also consider the following points:

The main rule for contributing to either a traditional or Roth IRA is, you or your spouse need to have earned income during that year.

Please be aware; IRA contribution limits apply based on your adjusted gross income amount.

1. Earned income includes wages, salaries, tips, bonuses, commissions or earnings from self-employment.
2. What is not counted as earned income cannot be deposited into your IRA include; dividends, interest, capital gains or distributions from retirement accounts.

Note;  Social Security does not qualify as earned income, and can’t be contributed to an IRA.

Medicare and HSA Contributions:

If you have a Health Savings Account (HSA), contributing to it can provide significant tax benefits. However, once you enroll in Medicare, you can no longer contribute to an HSA.

RMDs and Retirement Accounts:

Once you reach either  72 or (73 starting in 2023) ,  you must begin taking Required Minimum Distributions (RMDs) from your retirement accounts. Make sure to plan for this additional income in retirement.

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Advanced Diabetes Supply: Agent Support Program

There are multitudinous programs available to agents through agencies and other partners that they work with. Some of these features come in the form of agent support programs. One of the organizations that works with Crowe and Associates is Advanced Diabetes Supply, a trusted supplier of diabetes supply products since 2002. They are a leading national distributor of Durable Medical Equipment (DME) and specialize in supplies for clients handling their diabetes diagnosis. Because of their national presence and range, they are able to provide efficiency, payor coverage, and flexibility.

In addition to this, Advanced Diabetes Supply provides a free agent support program. This is a personalized retention service in which they work with the agent to provide excellent care to their clients with diabetes. Nearly one third of the beneficiaries on Medicare are diabetic, and therefore this agent support program can help ensure retention of up to a third of an agent’s business book. Additionally, 26.4 million people over the age of sixty-five are pre-diabetic, which is a considerable 48.8% of that group. An account executive from ADS (Advanced Diabetes Supply) works with the agent to provide sales and retention support for their clients living with diabetes.

While working with the agent to provide retention, Advanced Diabetes Supply can also provide supplies to their beneficiaries. These supplies include blood glucose meters, test strips, lancets, lancing devices, and control solution. Also available are continuous glucose monitors, insulin pumps and supplies associated with those, including Medtronic and Tandem pumps, infusion sets, reservoirs, and cartridges. ADS is also in a position to supply clients with necessities that fall under Medicare Part D, such as Omnipod dash/5, insulin syringes and pen needles, and alcohol wipes.

Using the Service

It is very simple for an agent to take advantage of this free support service. The first thing to do is check if their client has diabetes. If they do have diabetes, the agent can then forward their client’s contact information to the account executive from ADS at point of sale – there is a secure “refer a client” link for this purpose. The account executive will then call the client and help them set up easy home deliveries for any supplies that they may need with free shipping. This makes the beneficiary’s life easier and helps the agent provide them with excellent service, increasing retention through ADS’ free agent support program.

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