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

Big things are happening with MedicareCENTER and these new enhancements are making it even easier for our agents to sell more, earn more and grow more.
Let's dive right in! The call recording feature built into MedicareCENTER allows agents to compliantly record their phone calls when they're selling Medicare Advantage and Prescription Drug plans. It also allows them to access those calls any time they need them - as they'll be stored for 10 years. And there is no charge for this service. As with all the tools built into MedicareCENTER, the platform is complimentary for agents working with us.

The MedicareCENTER mobile app is now available in the App Store and the Google Play store and has all of the same capabilities as the web version. This makes managing your business even easier! Download the app and login to take your business where ever you go on your phone or tablet.

The next feature we're going to discuss is the personal URL which allows your clients to shop and enroll on our consumer-facing website, MedicareEnroll.com. When clients use your personalized link, they will see your contact information. They’ll be able to shop, compare and enroll in the Medicare plans you’re appointed to sell — and you’ll get the commission! ​

The newest feature to be integrated with MedicareCENTER is our LeadCENTER which allows our agents to receive leads directly into MedicareCENTER with the flip of a switch. This new tool allows agents to receive verified leads as soon as they're online and ready to receive phone calls. 

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