Medicare’s Final Rule and You 2022

Leah Sugar Kari is a local, licensed insurance agent and retired pharmaceutical representative.

What is the Final Rule? There are many ways Medicare protects you, the Medicare beneficiary, from bait and switch tactics and unclear or misleading information about Medicare Advantage, Part D Prescription Drug Plans, and Medicare Supplement Insurance plans. Recently, the Centers for Medicare and Medicaid (CMS) issued its Final Rule on May 9, 2022. This Final Rule is a strong step toward improving accuracy and full disclosure for beneficiaries when they are discussing plan options and enrolling in coverage. The rule will be in effect Saturday, October 1, 2022, and onward. The goal is to ensure that you, the beneficiary, receive accurate and accessible information about Medicare coverage.

What caused this? Medicare experienced a significant increase in complaints from beneficiaries about aggressive sales tactics by telemarketers. This prompted an investigation and the outcome was Medicare's strengthening the marketing and communications requirements for third party marketing organizations (TPMO) and individuals who must comply with these regulations.

Who has to follow the Final Rule? Medicare defines third party marketing organizations (TPMO) as "organizations and individuals, including independent agents and brokers, who are compensated to perform lead generation, marketing, sales, and enrollment related functions as a part of the chain of enrollment (the steps taken by a beneficiary from becoming aware of an MA plan or plans to making an enrollment decision)."

How will this affect you?

There are two important requirements of the CMS Final Rule that will directly affect independent licensed agents and brokers who sell Medicare Advantage and Part D Prescription Drug Plans as well as the large telemarketing organizations. The first requirement is that a disclaimer must be announced to the caller within the first minute of a sales call between an independent agent or broker or TPMO that states: "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact medicare.gov or 1-800-is Medicare (TTY users should call 1-877-486-2048) 24 hours a day/seveb days a week to get information on all of your options."

The second requirement is that all calls with Medicare beneficiaries that could potentially become part of the "chain of enrollment" need to be recorded. The announcement that the call is being recorded needs to be disclosed at the beginning of the sales call.

What's in it for you? The disclaimer about not offering every plan directs Medicare beneficiaries to see a complete list of plans offered in their state by accessing Medicare.gov or calling Medicare. The telemarketing organizations do not offer every available plan, nor do most agents or brokers. There are 65 Medicare supplement carriers listed in Arizona as well as 27 standalone drug plans, 39 Medicare Advantage plans listed in Pinal County, and forty-eight in Pima County for 2022. This is an extensive list for someone to cull through, but it is important that one is able to access every plan filed in Arizona.

The recording of your telephone call is a good protection for the consumer, providing a record of the initial call to the enrollment. The calls that will be required to be recorded will be safely stored per Medicare's requirement for 10-years and available for Medicare to audit if Medicare deems it necessary. Medicare's increased protection of you as the beneficiary underscores the pluses of being a Medicare beneficiary. Enjoy your well-earned benefit, confident in Medicare's increased protections for your wellbeing.

42 CFR 422.2260 "Third party marketing organization (TPMO)" or www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-422/subpart-V#p-422.2260(Third-party%20marketing%20organization%20(TPMO))

Leah Sugar Kari specializes in showing Medicare eligible people their insurance options. Reach Leah for comments at (520) 484-3807 or email [email protected]. (TTY users dial 711.)