Compliance (1)

CMS Final Rule for 2025 states: “Beneficiary information collected by a third-party marketing organization (TPMO), including an agent/broker for purposes of marketing or enrolling the beneficiary into a Medicare health plan or Part D plan may only be shared with another TPMO when prior written consent is given by the beneficiary. The consent must list each entity receiving the data.”

What this means to you as an Agent:

You cannot share beneficiary contact information with another agent/TPMO unless the beneficiary has given written permission. This necessitates a change in verbiage on Lead Generation Forms (BRC/PTC). Spark will be using the following disclaimer on their BRC/PTC forms, you are welcome to use as well:

“By providing your name and contact information you are consenting to receive sales and marketing calls, text messages and/or emails from the licensed insurance agent listed on this form about Medicare Plans at the number provided, and you agree such calls and/or text messages may use an automated system for the selection or dialing of telephone numbers, automated voice calls, AI generative voice calls, pre recorded messages played when a connection is made, or pre recorded voicemail messages, even if you are on a government do-not-call registry. These calls are for marketing purposes and cellular charges may apply.  This agreement is not a condition of enrollment and you can change your permission preferences at any time by contacting the agent listed on this form. “

Starting in 2025, full dual-eligible beneficiaries will have access to a new monthly SEP, which allows enrollment in highly or fully integrated Dual Special Needs Plans (HIDE/FIDE SNPs). In addition, any beneficiary qualified for LIS or Medicaid will be eligible for a monthly SEP to disenroll from their Medicare Advantage plan, return to Original Medicare, and enroll in a Prescription Drug Plan (PDP).

The quarterly SEP that many have used in the past for dual-eligible individuals and those receiving Part D low-income subsidies (LIS) is no longer available. The SEP available for the first 3 quarters of the year ended on September 30, 2024.

UHC has state guides on Jarvis. Here are instructions: Jarvis>Knowledge Center>Medicare Product Resources>Dual Eligible Special Needs Plans>State-Level D-SNP Enrollment at a Glance Guides>State (click on state of client’s residence)

Devoted has a FAQ: Devoted Health Plans 2025 SNP FAQ’s

Wellcare has a 2025 Dual Eligible Plan Enrollment guide:

Beginning April 1, 2025 individuals wishing to use the Disaster/Emergency SEP must call 1-800-MEDICARE in order to make the election. Plans are required to remove the Disaster/Emergency SEP from enrollment forms and the Plans will only receive the enrollments from CMS. Here is the full CMS memo dated 12/3/2024.

The Medicare Communications and Marketing Guidelines (MCMG) differentiate between educational and marketing events. At educational events, the focus is on informing beneficiaries about Medicare Advantage, Prescription Drug, or other Medicare programs without steering them towards a specific plan.  Agents/presenters are not allowed to discuss any individual plan specific information such as premiums, co-pays, or plan specific benefits.

Educational Events should be held in a public setting, such as a restaurant or public library.  They should not be held in-home or one-on-one settings.

Educational Events do not have to be filed with CMS.

You can advertise Educational Events through most forms of media including newspaper, radio, flyers, direct mail and social media.  There are a few guidelines when marketing educational events:

• All educational events must be explicitly marketed as “educational” to beneficiaries
• Ads and invitations must contain this disclaimer: “For accommodations of persons with special needs at meetings call <insert phone and TTY number>.” Click this link for more information on TTY.
  711 for TTY-Based Telecommunications Relay Service

Agents are allowed to have other “community partners” co-sponsor and be present at the event.  Examples include Realtors, Financial and Investment Advisors, and other senior focused businesses in the area.

Meals may be provided at educational events.  There is currently (2024 selling year) not a dollar limit on the meals as CMS has excluded meals at an educational event under the nominal gift rule. See page 10 of Medicare Communications and Marketing Guidelines (MCMG):  CMS MCMG

Here are more Do’s and Don’ts for Educational Events:

Open link below for more specific information and rules:

Most carriers require events to be filed at least 14 days in advance, so plan accordingly.

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Humana

Use Humana’s QR code to register events.

Scan the QR code below and follow the instructions.

CMS Federal Register

In 2024, CMS is introducing significant changes to the CMS Marketing Guidelines. The changes are aimed at improving the quality of healthcare services and ensuring that patients receive the right information. They will become effective September 30, 2023.

The primary changes you should be aware of:

• Call recording is limited to the point of enrollment: you no longer need to record appointment scheduling or retention activities
• 48-Hour SOA rule: you will need a signed Scope of Appointment (SOA) form 48 hours prior to the appointment. Exceptions include: the beneficiary is 4 days within the end of a valid election period, or the beneficiary is a walk-in
• Updated disclaimer on Marketing assets: Please use this disclaimer 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." Build your disclaimer HERE.
• You may no longer use the Medicare Name, Logo or Card misleadingly: we recommend not using images of the Medicare card until CMS gives further guidance

These are the additional changes per the Federal Register:

• Plans must notify enrollees annually, in writing, of the ability to opt out of phone calls regarding MA and Part D plan business.
• Agents must explain the effect of an enrollee's enrollment choice on their current coverage whenever the enrollee makes an enrollment decision.
• Limit the time that a sales agent can call a potential enrollee to no more than 12 months following the date that the enrollee first asked for information.
• Prohibit a marketing event from occurring within 12 hours of an educational event at the same location.
• Clarify that the prohibition on door-to-door contact without a prior appointment still applies after the collection of a business reply card (BRC) or scope of appointment (SOA).
• Prohibit marketing of benefits in a service area where those benefits are not available, unless unavoidable because of the use of local or regional media that covers the service area(s)
• Prohibit the marketing of information about savings available that are based on a comparison of typical expenses borne by uninsured individuals, unpaid costs of dually eligible beneficiaries, or other unrealized costs of a Medicare beneficiary.
• Require TPMOs to list or mention all the MA organizations or Part D sponsors that they represent on marketing materials.
• Require MA organizations and Part D sponsors to have an oversight plan that monitors agent/broker activities and reports agent/broker non-compliance to CMS.
• Modify the TPMO disclaimer to add SHIPs as an option for beneficiaries to obtain additional help
• Prohibit the collection of Scope of Appointment cards at educational events.
• Prohibit the use of superlatives (for example, words like "best" or "most") in marketing unless the material provides documentation to support the statement and the documentation is based on data from the current or prior year.
• Clarify the requirement to record calls between TPMOs and beneficiaries, such that it is clear that the requirement includes virtual connections such as video conferencing and other virtual telepresence methods.

• Prohibition on Open Enrollment Period Marketing:
• Agency Partners/agents are prohibited from knowingly targeting or sending unsolicited marketing materials to any MA enrollee or Part D enrollee during the continuous Open Enrollment Period (OEP) (January 1 to March 31).
• During the OEP, agency partners/agents may:
• Conduct marketing activities that focus on other enrollment opportunities including but not limited to:
• Marketing to age-ins (who have not yet made an enrollment decision),
• 5-star plans marketing the continuous enrollment SEP, and
• Marketing to dual-eligible and LIS beneficiaries who, in general may make changes once per calendar quarter during the first nine months of the year.
• Send marketing materials when a beneficiary makes a proactive request
• At the beneficiary’s request, have one-on-one meetings with a sales agent
• At the beneficiary’s request, provide information on the OEP through the call center
• Partners may include general information on their website about enrollment periods, including the OEP, as long as it is educational in nature, and a call to action is not present.
• During the OEP, agency partners/agents may not:
• Send unsolicited materials advertising the ability/opportunity to make an additional enrollment change or referencing the OEP
• Specifically target beneficiaries who are in the OEP because they made a choice during Annual Enrollment Period (AEP) by purchase of mailing lists or other means of identification
• Engage in or promote agent/broker activities that intend to target the OEP as an opportunity to make further sales
• Call or otherwise contact former enrollees who have selected a new plan during the AEP
• Words to avoid during in OEP/ROY marketing:
• Using the word NEW in a context that gives the impression that new plans are being released by plan sponsors.