CMS Closely Monitoring Agents Marketing Medicare Advantage & Prescription Drug Plans During AEP

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. ​​

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CMS recommends that TPMOs immediately implement the following:

• 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

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