Changes to How Agencies Can Market Medicare Advantage and Part D Plan

The U.S. Centers for Medicare and Medicaid Services (CMS) has recently released changes to how health insurance agents and brokers can market to customers. These changes aim to improve your experience when sourcing Medicare Advantage and Part D plans. 

Ensuring agents and plan providers follow the new guidelines helps you to make a more informed decision about your coverage.

Let's explore what these changes mean for you:

1. Clearer Advertisements

Both agents and health plan providers are prohibited from using any misleading tactics when advertising insurance plans. For example, they can’t use words like ‘best’, or ‘most’ unless there’s solid evidence available to support these claims. They also need to mention specific health plans and can’t advertise the benefits of a health plan or service unavailable in the area. If talking about savings, evidence needs to be based on a comparison of typical expenses incurred by someone without insurance, unpaid costs of dually-eligible beneficiaries and other Medicare beneficiary costs that are unrealized. 

2. No Misuse of Medicare Logo or Name

Medicare is cracking down on the use of its name and logo, to ensure customers aren’t confused or misled when purchasing the right health insurance for their needs and budget.

3. Better Sales Protection

Health plan salespeople and agents will no longer be able to make door-to-door sales without a prior appointment, even if they’ve collected a business reply card or scope of appointment (SOA). They can also only call someone within 12 months of first being asked for information.

In terms of events, SOA Cards may also not be collected at educational events and a marketing event can’t occur within 12 hours of an educational event in the same location. 

4. Scope of Appointment Changes

There now has to be a 48-hour window between you completing a scope of appointment (SOA) and meeting with a health agent. The only time this rule doesn’t apply is if you complete the SOA within the last four days of the election period. Or if you organize an in-person meeting with an agent. 

5. Improved Communication 

Having access to all the information helps to ensure you make the right decision for your healthcare coverage. Agents are required to explain how your enrollment choice impacts your existing coverage. They also need to answer important questions and topics as outlined by CMS. These cover topics such as costs, specialists, prescription drug coverage and primary care providers. 

6. Better Record-Keeping

To help provide more accountability and transparency, calls between agents and customers must now be recorded. This covers sales, marketing and enrollment calls. If agents use technology like Facetime or Zoom, only the audio will be recorded. Recording calls ensures there’s a record of the conversation if there are any disputes and also helps with protecting your personal information. 

7. Updated Disclaimer

Like other industries, such as financial services, when an agent calls customers, they have to provide a disclaimer within the first minute of the call. The disclaimer must include information about the State Health Insurance Program, offering additional resources and support.

8. Comprehensive Marketing Materials

Agents and agencies must list or mention all Medicare Advantage plan (MAPDs) or Part D plan (PDP) sponsors that they represent on all of their marketing materials. This can help ensure that you have an understanding of all the options available to you. 

When The New Rules Begin

The new rules will begin in 2024 to help customers research and enroll in the right plans for their needs. 

At Health Plans of NC, we’re committed to ensuring the best possible outcomes for our clients. We fully support these introductions to make sure that all agents are being transparent so customers get the best outcomes. 

Our agents help North Carolinians every day to understand the type of coverage they need.  Get in touch today if you want to find out how we can help you.