CMS Medicare Advantage and Part D 2024 Final Rule Changes
The Centers for Medicare and Medicaid Services (CMS) issued their Final Rule provisions for 2024 which will go into effect on September 30, 2023.
Outlined below are several of the changes that are important to note as you prepare for the 2024 Annual Enrollment Period (AEP). We also encourage you to visit the full 2024 CMS Final Rule
for more details.
PROHIBITS THE USE OF THE MEDICARE NAME, CMS LOGO, AND PRODUCTS OR INFORMATION ISSUED BY THE FEDERAL GOVERNMENT IN A MISLEADING WAY
Through CMS’ surveillance activities and beneficiary complaints, CMS noted that they have seen the word “Medicare” and the Department of Health & Human Services’ (HHS) logo being used in names of store fronts, postcards, websites, and printed materials in a misleading manner. CMS also noted there are numerous third-party sites with “Medicare” in the URL. CMS is concerned that beneficiaries are being misled into believing they are contacting Medicare or the Federal Government.
For these reasons, CMS is further restricting the use of the Medicare name, CMS logo and products and information issued by the Federal Government in a misleading way, including the Medicare card, in a misleading manner.
While CMS has clarified that they are not requiring that MA organizations and Part D sponsors discontinue use of the Medicare name if it is not used in a “misleading way”, these new restrictions will put increased scrutiny on brokers and agencies.
MODIFICATIONS TO THE THIRD-PARTY MARKETING ORGANIZATION (TMPO) DISCLAIMER
CMS has modified the TPMO disclaimer, requiring that the following now be included:
- Mention of the State Health Insurance Program (SHIP)
- The number of Medicare Advantage organizations or Part D sponsors available to the beneficiary
- The total number of products available to the beneficiary
If you are marketing Medicare Advantage or Part D products, you must include the appropriate TPMO disclaimer on all marketing materials (print and electronic), website, and within the first minute of audio scripts or calls. The disclaimer must be specific to the beneficiary’s service area.
Revised disclaimer for TPMOs that DO NOT sell all MA and/or Part D plans within a service area:
Revised disclaimer for TPMOs that DO sell all MA and/or Part D plans within a service area:
- “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.”
REQUIRES 48 HOURS BETWEEN A SCOPE OF APPOINTMENT (SOA) AND AN APPOINTMENT
- “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.”
The broker must agree upon and record the Scope of Appointment with the beneficiary(ies) at least 48 hours prior to any scheduled appointment or personal marketing, except in the following cases:
LIMITS ON HOW LONG SCOPE OF APPOINTMENTS (SOA) AND BUSINESS REPLY CARDS (BRC) ARE VALID
- SOAs that are completed during the last four days of a valid election period for the beneficiary.
- Unscheduled in-person meetings (walk-ins) initiated by the beneficiary.
Scope of Appointments (SOA) and Business Reply Cards (BRC) are now only valid for a 12-month period from when the beneficiary signed their request for more information. You will need to get a new Scope of Appointment or permission to contact (PTC) if the original has expired.
CLARIFIES THAT CALL RECORDING INCLUDES VIRTUAL CALLS
When conducting marketing, sales, or enrollment calls virtually (e.g., video calls), agents must still record the calls. However, only the audio portion of the calls needs to be recorded (not the video portion).
LIMITS CALL RECORDING RULE TO MARKETING, SALES, AND ENROLLMENT CALLS ONLY
Previously, the rule required TPMOs to record all calls with beneficiaries. CMS has revised this, limiting calls that need to be recorded to only those regarding sales, marketing, and enrollment.
“Marketing” includes “retention-based marketing,” or influencing a beneficiary’s decision to stay enrolled in a plan. Starting July 10, 2023, “marketing” also includes materials that mention any benefits, including widely available ones, such as dental, vision, and hearing, premium reduction, and cost savings.
It is no longer required to record calls for merely setting up in-person meetings, to confirm a beneficiary received a plan welcome packet, or calls to provide a beneficiary the opportunity to ask non-marketing questions.
For other important changes to note, click HERE
or visit the full 2024 CMS Final Rule
We understand the challenges many brokers will face with these new requirements and navigating Medicare compliance. Our dedicated team of experts is ready to help answer your questions and get you ready for AEP.