Medicare Final Rule 2024
Every year, the Center for Medicare and Medicaid Services (CMS) adjusts and makes amendments to the requirements and regulations that govern Medicare Advantage plans. For this coming year, 2024, there are important new requirements for third-party marketing organizations (TPMOs). Aetna, one of the primary carriers of Medicare Advantage insurance plans, sent a press release explaining the key points of the final ruling for the new marketing requirements. What is the Medicare Final Rule 2024?
Beginning September 30, 2023
These are some of the most pertinent changes and new regulations that will govern how brokers can market Aetna Medicare Advantage plans in the coming year. The following changes will be effective on September 30 of 2023:
Third-party marketing organizations that are authorized to sell Medicare Advantage must submit their multi-plan marketing materials to the Health Plan Management System (HPMS). This happens after it has been pre-reviewed by Medicare Advantage organizations. Health Plan Management System is a website where health insurance and prescription insurance plans, plan consultants, third-party vendors (like agents), and pharmaceutical manufacturers can fulfill the compliance requirements of Medicare Advantage and Medicare Part D plans.
Superlatives (best, most, etc.) are no longer to be used in marketing communications unless certain pre-existing documentation needs are met.
Any marketing materials that use the Medicare ID card image must be approved and authorized by CMS before use.
When marketing any products, plans, costs, etc., the Medicare Advantage organization name must be visible as it is listed in the HPMS.
Plan benefits must be advertised in the area that is eligible for their services.
Marketing materials cannot compare the costs of the uninsured in order to advertise potential savings due to a Medicare Advantage plan.
In addition to these new requirements, CMS has updated the definition of marketing. This new, clarified definition broadens the content that is classified as marketing. Any type of materials that mention plan benefits is now considered marketing material.
Medicare Final Rule 2024 – Marketing Materials
In order to be in compliance with the updated regulations from CMS (the Center for Medicare and Medicaid Services), third-party marketing organizations (TPMOs) such as brokers must make sure their sales and marketing materials are in line with the following requirements:
It is always prohibited to visit a beneficiary without an appointment. This is the rule even if the beneficiary has expressed that they are interested in a Medicare Advantage insurance plan or product.
Medicare Advantage organizations need to provide customers with an annual opportunity to opt out of plan marketing calls. There will likely be further clarification on this topic from carriers such as Aetna to their third-party marketing organizations (TPMOs).
Events
If a Medicare Advantage organization is holding an educational event, they can no longer set up personal marketing appointments for the future at said educational event. The organization is also prohibited from asking beneficiaries to complete the Scope of Appointment forms at the educational event. There needs to be a sharp divide between educational and marketing events.
Marketing events and educational events must take place more than 12 hours apart in the same location. When the regulation uses the term “same location,” it means the same building or adjacent buildings.
There must be at least 48 hours between the beneficiary completing the Scope of Appointment forms and the beginning of the personal marketing appointment.
A beneficiary’s request for information is valid for 12 months from the signature. This applies to Scope of Appointment forms, business reply cards, and any other requests to receive additional information.
Before enrollment, the beneficiary must be provided with a pre-enrollment checklist (PECL). This applies to enrollments made over the telephone.
In their disclaimer, TPMOs must provide the number of plans and products they offer. Those who offer all plans and products must also provide a version of this information in their disclaimer.
Beneficiary health plan needs will be reviewed before enrollment.
TPMOs must record the entirety of all of their marketing, sales, and enrollment calls. This includes the audio of any web-based marketing calls. Other types of calls do not need to be recorded in their entirety.
As is evident by the new requirements for compliance from CMS, the industry takes the ethics of marketing and selling Medicare Advantage very seriously and will continue to adjust to a changing marketplace.
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