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Understanding Medicare Marketing Rules for Third-Party Marketing Organizations

The Centers for Medicare and Medicaid Services (CMS) has finalized new Medicare marketing rules and guidelines that could mean big changes for insurance wholesalers and agents before the 2023 Annual Election Period – also known as Medicare Open Enrollment – starts in October this year.

The Marketing guidelines reflect CMS’ interpretation of the marketing requirements and related provisions of the Medicare Advantage and Medicare Prescription Drug Benefit rules (Chapter 42 of the Code of Federal Regulations, Parts 422 and 423).

The guidelines are for use by Medicare Advantage Plans (MAs), Medicare Advantage Prescription Drug Plans (MA-PDs), Prescription Drug Plans (PDPs), and 1876 Cost Plans. The guidelines allow organizations offering both Medicare Advantage and Prescription Drug Plans the ability to reference one document when developing marketing materials.

CMS adopted these new requirements applicable to all third-party marketing organizations (TPMO), which must comply with these requirements. CMS also changed its process for a third-party submission of multi-plan marketing materials to CMS and clarified its definition of “marketing” in such a way that broadens how many MA and PDP marketing downlines previously thought about marketing. Third parties need to submit all materials to CMS that include marketing content, as the term “marketing” has been clarified by CMS.

AIP Marketing Alliance (AIPMA) wants to provide some basic guidance on how the CMS marketing rules could affect independent wholesalers and agents as they prepare for the 2023 AEP with their current and prospective clients. This information is for educational use only, and licensed Medicare agents should review these new marketing guidelines before the 2023 open enrollment period starts as some of the new requirements of the CMS marketing rules go into effect October 1, 2022. The remainder of these rules go into effect January 1, 2023.

Let’s talk about Third-Party Marketing Organizations first. A TPMO is an organization or individual, including independent agents and brokers, who is compensated to perform lead generation, marketing, sales, and enrollment-related functions as part of the chain of enrollment.

  • This means NMOs, FMOs, agencies, brokerages, independent agents, and brokers are all TPMOs.
  • Lead vendors and other vendors or subcontractors who are compensated to perform lead generation or marketing for a plan or for a first-tier, downstream, or related entity (FDR) are also TPMOs.

Each TPMO also must use a specific disclaimer when selling the highlighted Medicare products in the third paragraph above, and the wording may not be changed. This disclaimer is as follows:

  • “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-MEDICARE to get information on all of your options.”

TPMOs must use the TPMO Disclaimer in all of the following scenarios:

  • Verbally within the first minute of a sales call
  • Electronically when communicating with a beneficiary through email, online chat, or other electronic means of communication
  • Prominently on your TPMO website
  • All marketing materials, including print materials and TV ads that you develop, use, or distribute

TPMOs are NOT required to use the TPMO Disclaimer in these scenarios:

  • When meeting with a beneficiary in person
  • If you only sell plans on behalf of one carrier
  • If you sell plans on behalf of more than one carrier and you sell all commercially available MA or PDP plans in a given service area

Another important part to understand about these new CMS marketing rules involves how CMS will require TPMOs to record all phone calls involved throughout the enrollment process. The verbal conveyance of the TPMO Disclaimer also is required in the first minute of a sales call, but not in the first minute of all calls.

TPMOs must record all calls with beneficiaries in their entirety, including the enrollment process. Absent further clarification from CMS, this requirement appears to include inbound and outbound calls with consumers associated with the chain of enrollment, including lead generation, marketing, and the enrollment process.

Due to state recording laws, the TPMO sales agent must notify the consumer at the outset of inbound and outbound calls that the call is being recorded with a statement of “This call is being recorded.” Each state has different stances on recording phone calls, so you should keep this in mind.

If a consumer declines to be recorded, then the TPMO agent must inform the client/prospect that government regulations require the call to be recorded. If the client still does not consent, then the TPMO agent cannot continue the sales call and must end the call with the client/prospect.

AIPMA wants to share some of the recent information created by CMS. PLEASE NOTE: The information herein provided is incomplete due to some of the recent CMS-required changes going into effect in a matter of a few weeks. At this time, AIPMA will not cover this material as our team believes the main two changes – involving the TPMO disclaimer and recording telephone calls – are more important and will affect sales campaigns during the Medicare Open Enrollment period. We recommend using each Medicare carrier’s sales and marketing materials vs. creating new resources as carrier pieces are approved for use by CMS.

AIPMA also is working with Integrity Marketing Group to help prepare wholesalers and agents for the 2023 AEP. We hope to have an agent guide available soon explaining the new CMS marketing guidelines in more detail. If you have any interest in these materials, please contact AIPMA at marketing@aipma.com.

This information is considered for educational use only. You should review the CMS Medicare marketing rules on their website.

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