Clarifying Medicare Advantage marketing rules

The Centers for Medicare and Medicaid Services has been cracking down on Medicare Advantage marketing, leaving Medicare agents subject to rules that were intended to shut out the companies flooding the TV airwaves with misleading advertising.

Mike Smith, president of The Brokerage Inc., clarified some of those Medicare Advantage marketing rules for the 2024 open enrollment season during a presentation at the National Association of Benefits and Insurance Professionals annual convention.

Smith said there haven’t been any major changes in the Medicare Advantage marketing rules for 2024, but he reviewed some of the current rules as well as presented some updates.

The CMS rules led to two major requirements that impacted brokers, Smith said. One was the requirement that brokers all calls involving Medicare Advantage enrollments. The other was including agents and brokers in the CMS definition of a third-party marketing organization.

One thing CMS is emphasizing to brokers, Smith said, relates to scope of appointment. He said CMS is making sure brokers have secured a scope appointment at least 48 hours in advance of making any type of formal Medicare Advantage sales presentation.

Smith also reviewed new rules governing Medicare Advantage educational events.

“These events must be educational in nature and you cannot conduct a sales event or a sales enrollment within 12 hours after you have an education event,” he said.

Another rule, he said, governs the use of the Medicare logo and the word “Medicare” in advertising.

“The intent here is that CMS does not want anyone to misrepresent themselves or try to suggest that they are affiliated in any way with some government entity, such as Medicare or Medicaid. CMS does not want the word ‘Medicare’ to be used in any type of advertisement without approval. So that will mean additional requirements for brokers who have any type of homemade advertising or anything that would be designed to market or steer consumers toward a certain plan that will then have to be approved either by the carrier or by an upline field marketing organization.”

Brokers have questions about a CMS rule regarding use of a new disclaimer on Medicare Advantage marketing, Smith said.

“It’s the fact that we now have to name how many carriers and how many plans we offer at any type of an email signature or other marketing,” he said. “That’s causing concern, because we may be offering certain plans that are available in a particular state. And while they may be the same plan that’s available in another state, the agent may not be able to sell in those other states. If I have a nonresident license in a particular state, do I have to list all of the states that I represent or all of the plans and carriers that I represent in those states? Or do I just need to represent the plans that I offer by county? We’ve sought additional guidance from CMS on this.”

Brokers face additional requirements regarding a Medicare Advantage pre-enrollment checklist, Smith said.

“While this is something that most of the carriers offer in their enrollment packets, CMS is now specifically requesting this, so it’s causing questions among brokers,” he said. “There is not a standard pre-enrollment checklist. But CMS regulations states that you are to use a standard pre-enrollment checklist. So we have sought advice from our carriers about this.

“At this point, the best thing we can do is suggest that if you’re going to write a plan with certain carriers, that you use their pre-enrollment checklist, which has already been pre-approved by CMS.”

 

Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected]. Follow her on Twitter @INNsusan.

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