CMS released a memo last week regarding the marketing practices of TPMOs (Third Party Marketing Organizations - which includes independent insurance agents.) during the Annual Enrollment Period. They are quite concerned because they have reviewed thousands of complaints and numerous recorded phone calls and have identified issues with regard to the information that is being provided to consumers. 

CMS has been conducting a "Secret Shopping" program by calling numbers associated with Medicare Advantage and PDP marketing efforts (tv and newspaper ads, internet searches and mailers) and these secret shoppers have been receiving inaccurate or misleading information regarding plans they inquired about. Additionally, some TPMOs are not complying with the new regulations put into place, and some are even pressuring consumers into purchasing plans that may not be the best fit for them or have been misrepresented.

CMS is closely monitoring all activities during the open enrollment period, and will take compliance action for activities and materials that do not meet their requirements. ​​

​To learn more...

• Ensure beneficiaries know how to file a marketing complaint with 1-800-MEDICARE or the plan, as well as highlight for beneficiaries that it is important to provide an agent or broker name, if possible. Plans must clearly display this information on plan websites and include this information in all mailings.
• Immediately review all allegations raised by any source against an agent or broker.
• Take all necessary and appropriate action to address inappropriate agent behavior.
• Track complaints against each agent or broker, looking for any outliers with respect to rapid dis-enrollments.
• Ensure agents and brokers obtain Scope of Appointment (SOA) forms. Plans should remind agents and brokers that they may only discuss products with potential enrollees that have been agreed to in advance on the SOA. CMS retains the right to request copies of SOAs.
• Review “upstream” entities associated with agents who are outliers with respect to complaint numbers and determine potential patterns or connections to potentially inappropriate Field Marketing Organization activities.
• Ensure all agents and plan marketing materials clearly state when certain benefits may not be available to all enrollees. CMS may determine that the agent’s activity or marketing is misleading if the benefits being marketed are only available to a subset of plan members.
• Ensure all agents and brokers review the required Pre-Enrollment Checklist with a beneficiary prior to enrollment. The items in this checklist must be covered in full and the agent must confirm that the beneficiary understands all items addressed.
• Provide translation services for beneficiaries with limited English proficiency. For those beneficiaries who have requested documents in a language other than English, the plan must continue to provide required documents in that language until the beneficiary has changed his or her request.
• Provide agents a list of required questions or topic that they must cover in their sales presentations particularly basic topics or questions, such as use of provider specialists, whether the beneficiary is looking for a lower premiums and copays, may need DME, or whether the beneficiary has questions about the costs associated with the plan.​​
  

By Carolyn Portanova

On May 9, 2022 CMS put into place the following rules for marketing and communications with regard to offering Medicare Advantage and Prescription Drug Plans for 2023. 

When marketing Medicare Advantage and Prescription Drug Plans the following language must include:

​“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.”

The message above must be: 

• Verbally conveyed within the first minute of a sales call.
• Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication.
• Prominently displayed on agent/agency websites and in email signatures.
• Included in any marketing materials, print materials and advertising.

If you're using marketing materials this AEP be sure to update them or request marketing materials from us with the disclaimer above. It's crucial to be compliant and be sure to follow the rules put forth by CMS.
​
You are NOT required to use the disclaimer when meeting with a Medicare beneficiary in person, if you only sell plans on behalf of one carrier, OR 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. Additionally, it's always best to include “Not connected with or endorsed by the United States government or the federal Medicare program.” on any marketing materials you use.

Learn more about the CMS Communications & Marketing Guidelines. 
Download the Agent Dos & Dont's from CMS.

Additionally, recording of all phone interactions between agents and consumers discussing MA and PDP must take place and recordings must be stored for 10 years. You should record ALL calls in their entirety beginning on October 1, 2022.

​You must record all your calls with every beneficiary in their entirety. This includes all inbound and outbound calls including lead generation, marketing and the enrollment process. If you call an existing client or receive a call from an existing client and you believe that the call may lead to enrollment, then you should record the call from the outset. This can include: lead generation, marketing, discussing different plans, mid-year reviews, Medicare educational discussions on options, annual check-ins, or any other topic that involves the selling/enrollment of a Medicare Advantage or Prescription Drug plan.

Many states require that consumers be notified that their call is being recorded. As a best practice you should tell the consumer at the start of each call that the call is being recorded and explain to them why the Centers for Medicare & Medicaid Services has put this rule into effect. Make sure the notification is documented on the recording. If a consumer stays on the line, they have consented to the recorded call. If they don't wish to be recorded, then it's best to politely end the conversation.

Example:
“I understand that you may not wish to be recorded; however, new government regulations require certain calls with Medicare beneficiaries be recorded. In order for me to my due diligence and be compliant I must get your permission to record our conversation. The purpose of this rule is to ensure that the information that I give you is accurate.”
​
​Read more about the CMS rule here...​

New call recording capabilities will be available in MedicareCENTER and will include the following:

• Inbound call recording, store and download solutions
• Outbound call recording, store and download solutions
• Call recordings storing for 10 years, as required by CMS
• CMS-required scripting for the beginning of each prospect call

What else can you do in MedicareCENTER ​?

• Medicare Supplement quoting and enrollment
• Medicare Advantage quoting and enrollment
• Prescription Drug plan quoting and enrollment
• Maintain client information, tasks and follow-ups
• Get access to training modules and sales tips
• Lead generation

By utilizing our MedicareCENTER, you will be compliant and will have access to all of your clients' information. To learn more and get registered for MedicareCENTER, please visit our MedicareCENTER page.

Should you choose to use a different vendor for your call recording, please keep in mind that you are responsible for entering into an agreement with that vendor and paying for their service.

If you have questions about this CMS rule, please reach out to us for further information.

By Carolyn Portanova

Helping your clients avoid Medicare penalties is an important aspect of guiding and educating them. Below are some tips to help your clients enroll on time to avoid paying more.

Part A Penalties
​Most Medicare eligibles receive Part A for free however, if you have  a client who has to buy Part A, and they don't buy it when they're first eligible for Medicare (age 65), their monthly premium may go up by 10%. 

Your clients won't have to pay for Part A at age 65 if:

• They or their spouse has worked at least 40 quarters
• They already get retirement benefits from Social Security or the Railroad Retirement Board or they're eligible to get either of those benefits but just haven't filed for them yet.
• They or their spouse had Medicare-covered government employment.

​If your client has limited income and resources, their state may help pay for Part A.

Part B Penalties
​If your client doesn't sign up for Part B when they're first eligible, their monthly premium may go up 10% for each 12-month period that they could've had Part B. In most cases, they'll have to pay this penalty each time they pay their premiums, for as long as they have Part B. 

There is typically no late enrollment penalty if your client meets certain conditions that allows them to sign up for Part B during a Special Enrollment Period. As with Part A, if your client has limited income and resources, their state may help pay for Part B. 

If your client has other creditable coverage, they can delay Part B and postpone paying the premium. They can sign up later without a penalty, as long as they do it within eight months after their other coverage ends. There are directions on the back of their Medicare card if they want to refuse Part B.
 ​
​Part D Penalties
In order to avoid any Part D penalties make sure your client enrolls in drug coverage when they're first eligible. Even if they don’t take drugs they should consider joining a Part D Plan or a Medicare Advantage Plan that includes drug coverage. If they don't they may pay a late enrollment penalty if (at any time after their Initial Enrollment Period is over) there's a period of 63 days or more when they don't have Medicare drug coverage - or other creditable prescription drug coverage. 

Additionally, make sure they enroll in drug coverage if they lose other creditable coverage (from an employer, union, TriCare, Dept. of Affairs, etc.) that's expected to pay at least as much as Medicare's standard prescription drug coverage. You'll want to advise your clients to keep records showing when they have other creditable drug coverage in order to avoid possible penalties in the future. If your client disagrees with a penalty, they can request a review by completing a 'reconsideration request form'.

Avoiding Medicare penalties doesn't have to be tricky as long as you advise your clients accordingly. Review their specific situation to determine when they should enroll in the different parts of Medicare to avoid any issues.

​If you'd like to review the different enrollment periods, request our Medicare Enrollment Periods guide which goes over the following: 

• Medicare Annual Enrollment Period (AEP) ​
• Initial Enrollment Period (IEP)
• Medicare Advantage Open Enrollment Period (MAOEP) 
• Special Enrollment Period (SEP)
• Medigap Open Enrollment Period (MOEP)

By Carolyn Portanova

The Medicare Advantage Enrollment Period runs from January 1st - March 31st. ​​

If your client is unhappy with their current Medicare Advantage plan, they can make a switch to another Medicare Advantage Plan (with or without drug coverage). They can also dis-enroll from their Medicare Advantage Plan and return to original Medicare. If they choose to do so, they'll be able to join a Medicare Prescription Drug Plan as well (Part D).

​If they enrolled in a Medicare Advantage Plan during their Initial Enrollment Period, they can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without drug coverage) within the first three months they have Medicare.

If your client switches to a different Medicare Advantage Plan or goes back to original Medicare with or without a drug plan, their new coverage will start the first day of the month after their new plan gets the request for coverage. An important detail to remember though, if your client decides to go back to original Medicare, they may not be able to buy a Medicare Supplement policy.

​The best time for your client to get a Medicare Supplement policy is during their six month Medigap Open Enrollment Period. During that time they can purchase any Medicare Supplement policy sold in their state, even if they have health problems. This period starts the first month they have enrolled in Medicare Part B and they're age 65 or older.

There are many details to consider, before jumping off their current coverage. However, there are options if their current plan is not a good fit.

By Carolyn Portanova

The Annual Enrollment Period which occurs every fall is right around the corner. October 15th kicks off the beginning of that window when your clients can make changes to their Medicare Advantage plans. So now is the time to go through our AEP checklist to ensure you're ready for the busiest time of year. Whether you're selling Medicare Advantage products, Prescription Drug Plans, Medicare Supplement products or any combination of the three, being prepared is your best asset. Below we'll go over our AEP checklist as well as review what your clients can do during the Annual Enrollment Period which ends on December 7th.

​1. Change from Original Medicare to a Medicare Advantage plan (or vice versa)
2. Switch from one Medicare Advantage plan to another Medicare Advantage plan
3. Switch from a Medicare Advantage plan that doesn't have drug coverage to one that does offer drug coverage (or vice versa)
​4. Join a Medicare Prescription Drug Plan (PDP)
5. Switch from one Prescription Drug Plan (PDP) to another PDP
6. Drop Medicare Prescription Drug coverage completely

There are many scenarios that can play out during AEP and it's in your best interest to review your clients' policies with them to ensure they have appropriate coverage for the coming year. Many of your clients may want to review their Medicare Supplement plans during this time as well, and it's the perfect time to do so.

1. Contracting
​​If you need to finish any contracting you may have started, complete it and review any carriers you wish to add.​ Carriers have blackout dates where you can no longer move your contract. You can review our carrier black out dates on our AEP page.
​2. AHIP Training
Be sure to complete your AHIP training. Many carriers offer discounts, but you must access the training through the carriers' agent websites to receive that discount.
3. Product Training
​Login to agent sites and complete all product training. You'll get notified by the carrier when you’re eligible to being selling. Watch your Inbox carefully​.
​4. MedicareCENTER
Login to MedicareCENTER and get familiar with all the new tools available. Upload and update your clients in the CRM and review the training and best practices guides.
​5. Electronic Applications
Familiarize yourself with electronic applications now (before the rush). This will make them much easier to complete. You can download carrier e-App training guides from our Electronics App page.​
​6. Order Supplies & Materials
​Order any supplies you may need from your carriers directly, and be sure to request our complimentary*, branded marketing materials to help you promote yourself.

Make sure you're ready to go and have everything you need to make this your most successful AEP yet. We're here to help you succeed and are always available to assist you with your AEP strategy.

*Must be a contracted producer to qualify for our complimentary marketing materials.

By Carolyn Portanova