From 2020 to 2021, the number of complaints about deceptive practices in private sector marketing for Medicare Advantage doubled. These complaints led to an inquiry in 2022 that found widespread issues with practices being used in marketing.
As a result, the previous Medicare marketing rules had to be tightened and some even reinstated. Ultimately, this changes how insurance agents and third-party marketing organizations (TPMO) can do things.
In addition, not following these regulations can lead to penalties. Keep reading to learn more about the changes to Medicare marketing guidelines in 2023 and keep your business safe.
Why Do Guidelines Exist for Medicare Marketing?
Medicare marketing guidelines exist for a very important reason: to protect beneficiaries and ensure they receive accurate and unbiased information about their healthcare options. With so many Medicare plans available, it’s crucial that agents follow specific guidelines when promoting these plans to avoid misleading or confusing potential enrollees.
Prevent Fraudulent Activities and Deceptive Marketing Practices
The guidelines aim to prevent fraudulent activities and deceptive marketing practices. By setting clear rules, the Centers for Medicare & Medicaid Services (CMS) can crack down on unscrupulous agents who may try to take advantage of vulnerable individuals.
Create a Level Playing Field for Agents
The guidelines help maintain a level playing field among insurance agents. Agents must adhere to certain standards when advertising their services so that all have an equal opportunity to present their offerings in a fair manner.
Transparency in Communication
The guidelines promote transparency in communication. They require agents to provide accurate information about:
- Plan benefits
- Provider networks
- Enrollment processes
This ensures that beneficiaries have access to reliable details that enable them to make informed decisions regarding their healthcare coverage.
Regulation of Marketing Practices
Having strict guidelines in place allows CMS to monitor and regulate marketing practices effectively. This oversight helps identify any violations early on.
CMS can then take appropriate action against those who do not comply with the rules. It ultimately protects both consumers and honest agents who strive for ethical business practices.
Updates to CMS’ Definition of Marketing
What is marketing according to CMS? Understanding the answer to this question is necessary when you’re evaluating the materials you’re using.
According to CMS marketing is any mention of benefits that’s intended to do the following:
- Draw attention to a plan
- Influence the decision-making process of a potential beneficiary when choosing a plan
- Influence the beneficiary’s decision to remain enrolled in a plan
Another big part of the definition is intent. If the intent of the materials is to sell an insurance plan or encourage a beneficiary to renew their plan, it’s considered marketing.
If You Mention Benefits It’s Considered Marketing
In July of 2023, the rules around this changed. Prior to this mentioning benefits that were widely available was not considered marketing. However, with the update to the definition this changed.
Now any materials for Medicare Advantage, Part D, and Cost plans that talk about benefits with the intent to sell, fall under the definition of marketing.
This Continues to Be True When Discussing Retention Marketing
Retention marketing is all about keeping the customers you already have. It’s important to understand that rules surrounding marketing include this when we discuss some of the other changes that have been made this year by CMS.
Updates to Medicare Marketing Guidelines in 2023
The year 2023 brings some important updates to the Medicare Marketing Guidelines. These guidelines are essential for agents who work with Medicare beneficiaries and help them navigate their options for healthcare coverage. Let’s take a closer look at what these updates entail.
Oversight of Communications
When it comes to Medicare marketing, oversight of communications is crucial to ensure compliance with the guidelines set forth by the Centers for Medicare & Medicaid Services (CMS). In 2023, there are some important updates that agents should be aware of.
Review of Marketing Materials
It’s essential to remember that all marketing materials must be reviewed and approved. TPMOs will need to send any materials to the Health Plan Management System (HPMS) for approval.
Scope of Appointment Rules
Guidelines that regulate Scopes of Appointments are also changed. These changes took place on September 30, 2023.
Rule changes around this include the following:
- Scope of Appointments must be obtained 48 hours prior to marketing appointments, there are two exceptions to this rule
- Requests to be contacted are only valid for 12 months
- You may not hold marketing events immediately following educational events
- You can’t set up future sales events or collect Scope of Appointment forms during educational events
In the older guidelines, all calls were required to be recorded. With the updates, this is changing. This is important when considering retention marketing.
Any call that falls under the following categories must be recorded according to the updated 2023 guidelines:
- Marketing calls
- Sales calls
- Enrollment calls
If you’re on a video call, you must record the audio. However, you do not need a recording of the video.
Medicare and CMS Logo
The Medicare and CMS logo plays a crucial role in Medicare marketing. It serves as a visual representation of credibility and trust, helping beneficiaries easily identify legitimate Medicare communications. With the updates to the Medicare Marketing Guidelines in 2023, it is essential for agents to understand the guidelines surrounding the use of logos.
The changes here apply to the:
- Products of Medicare and CMS
New regulations prohibit using any of this to mislead people looking for insurance coverage. You will need to clearly explain that your materials are not coming from the government or Medicare.
You’ll also need to get approval from CMS to use certain images in your marketing materials. This includes an image of a Medicare card.
These rules prevent your marketing materials from appearing as if they’re from the government.
Disclaimers are an essential aspect of Medicare marketing guidelines in 2023. They serve as a way to provide important information and clarify any potential misunderstandings or misconceptions. These disclaimers help protect both the Medicare beneficiary and the agent by ensuring that accurate and relevant details are communicated.
Disclaimers need to be:
- Used within the first minute of a call
- Visibly placed on your website
- Shared electronically when using chat, email, or other electronic forms of communication
- Placed on all marketing materials
- Updated on older marketing materials
- Updated to state the number of plans and organizations you represent
CMS has created two different standard disclaimers. The first disclaimer applies to you if you don’t represent all carriers available in your service area.
This disclaimer states the following:
“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.”
If you do represent all carriers in your area, your required disclaimer reads a little differently. It includes the following:
“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.”
When it comes to marketing Medicare plans, one key aspect that agents need to be aware of are the guidelines surrounding unsubstantiated statements. In 2023, there have been some updates to these guidelines that agents should take note of.
First, it is important for agents to understand what constitutes an unsubstantiated statement. Essentially, this refers to making claims or promises about a Medicare plan without having proper evidence or proof to support those claims. This could include statements about benefits, coverage options, costs, or any other aspect of a Medicare plan.
The Centers for Medicare & Medicaid Services (CMS) takes unsubstantiated statements very seriously and has implemented stricter regulations around them in recent years. Agents must ensure that any information they provide regarding Medicare plans is accurate and supported by reliable sources.
To avoid running afoul of these guidelines, it is crucial for agents to thoroughly research and fact-check any claims they make about a Medicare plan. This means relying on reputable sources such as CMS publications or official plan documents rather than hearsay or personal opinions.
Restrict Marketing to Your Service Area
Another important aspect to consider with the new regulations is your service area. This refers to the geographic location where you are licensed and authorized to sell these plans.
New regulations state that your marketing efforts must be restricted to your service area. There are some exceptions to this rule. However, it’s only when marketing outside your service area is unavoidable.
The example given by the updated guidelines discusses using local media to market. At times the media provider may have a larger audience than your service area.
In this case, marketing outside your service area would be unavoidable.
Penalties for Non-Compliance With CMS Marketing Regulations
Understanding and adhering to Medicare marketing guidelines is crucial for agents who want to avoid potential penalties. The CMS takes non-compliance with these regulations seriously, as it can lead to misleading or fraudulent practices that could harm beneficiaries. Let’s take a closer look at the consequences of not following the rules.
CMS has the authority to impose civil monetary penalties on agents found in violation of marketing regulations. These fines can range from hundreds to thousands of dollars per violation, depending on the severity of the offense. It’s important to note that repeat offenders may face even higher penalties.
In August of 2023, Aultman Health Foundation received a civil money penalty (CMP) of $162,632.
In addition to civil monetary penalties, CMS may also impose other penalties on non-compliant agents, including:
- Suspension of marketing activities
- Suspension or termination of agent contracts
- Revocation of Medicare Advantage or Part D plan sponsor status
- Exclusion from participating in federal health care programs
- Legal action and criminal prosecution for fraud or abuse
Damage to Your Reputation
Non-compliant agents run the risk of damaging their reputation and losing credibility within their community and industry. Word travels fast in today’s digital age, and negative reviews or news about improper marketing practices can have long-lasting effects on an agent’s business prospects.
Companies facing sanctions are also listed on the CMS website. This means that anyone can see that you’ve engaged in practices that aren’t in compliance with CMS regulations.
How to Avoid CMS Penalties From Marketing
The penalties for violating regulations put in place by CMS are not ones to take lightly. In order to avoid CMS penalties and maintain a successful Medicare marketing strategy, there are several key steps agents should take:
Keep yourself updated with the latest changes in the Medicare Marketing Guidelines. Regularly review CMS communications and attend training sessions to ensure you have a clear understanding of what is expected.
Comply With Regulations
Familiarize yourself with all the specific rules and regulations outlined by CMS for marketing activities. Ensure that your marketing materials, including brochures, websites, social media posts, and advertisements follow these guidelines accurately.
Be transparent in all your communication with potential Medicare beneficiaries. Clearly state your role as an agent and provide accurate information about available plans without making false promises or misleading statements.
Document Your Compliance Efforts
Keep detailed records of all your compliance efforts like attendance at training sessions, document reviews etc. This will help you demonstrate your commitment if ever questioned by authorities
Seek Professional Guidance If Needed
Are you overwhelmed by the new regulations? If you’re unsure about any aspect of the Medicare Marketing Guidelines or need assistance in navigating through complex regulations seek guidance from experts who specialize in healthcare compliance
Stay Up-to-Date With the Latest Medicare Marketing Regulations
Staying up to date with the Medicare marketing guidelines is crucial for agents looking to effectively promote their services and comply with the regulations set forth by CMS. The updates to the Medicare marketing guidelines in 2023 bring about important changes that agents should be aware of.
TR King Insurance Marketing wants to help you find success as an agent. As your Insurance Field Marketing Organization, we’ll make sure you have the tools you need to double your income within 90 days. Find out more about the difference we make by scheduling a meeting to find out more about our services and get your questions answered.