Full Answer
What are the Medicare communications and marketing guidelines?
Sep 05, 2018 · The Medicare Communications and Marketing Guidelines (MCMG) interpret and provide guidance on the marketing and communication rules for Medicare Advantage (MA-only, MA- PD) plans (also referred to as “plans”), Medicare Prescription Drug plans (PDP) (also referred to
When does CMS consider a health plan a communication?
Aug 31, 2020 · Updates to the Website Requirements in the Medicare Communications and Marketing Guidelines. Guidance for updated sections 70.1, 90.1, and 90.4 of the Medicare Communications and Marketing Guidelines (MCMG) based on comments received following the release of the MCMG on July 20, 2018. Download the Guidance Document
Are You using the new CMS guidelines memo in conjunction?
Aug 06, 2019 · rely on the contract year (CY) 2019 Medicare Communications and Marketing Guidelines (MCMG), which can be found at . https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/FinalPartCMarketingGuidelines.html, subject to the updated guidance provided in this memorandum. Below are updates to the MCMG applicable to all …
Is outreach considered communications or marketing by CMS standards?
Jun 16, 2021 · CMS Medicare Communications and Marketing Guidelines (MCMG) DOs & DON’Ts Agent Summary . Last updated: 6/16/2021 – Based on current CMS regs and MCMG. CMS holds Plan Sponsors and Carriers responsible for anyone promoting their Medicare products . All must follow CMS regulations and guidelines in your daily Medicare activities.
What is CMS marketing rule?
Marketing Rules CMS also regulates marketing and plan presentations, including when you're allowed to market, and how you market. Agents must wait until October 1 to begin marketing next year's plans to potential beneficiaries and cannot enroll members until October 15.
Do Medicare Advantage plans follow CMS guidelines?
Medicare Advantage Plans Must Follow CMS Guidelines In the United States, according to federal law, Part C providers must provide their beneficiaries with all services and supplies that Original Medicare Parts A and B cover. They must also provide any additional benefits proclaimed in their Part C policy.
Who approves Medicare marketing materials?
All marketing materials need to be filed and approved by CMS. Agent created communications to members do not need CMS approval. Any agent created communication must follow the CMS Medicare Communications and Marketing Guidelines.
What are CMS permission to call guidelines?
Specifically, the Medicare Permission to Contact (PTC) rule outlines when it is okay to contact a current or potential Medicare beneficiary, the specific products they are giving you permission to contact them for, how you can approach them, and when you can contact them.Mar 25, 2020
Can you switch back and forth between Medicare and Medicare Advantage?
Yes, you can elect to switch to traditional Medicare from your Medicare Advantage plan during the Medicare Open Enrollment period, which runs from October 15 to December 7 each year. Your coverage under traditional Medicare will begin January 1 of the following year.
Can you have Medicare and Medicare Advantage at the same time?
If you join a Medicare Advantage Plan, you'll still have Medicare but you'll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare. You must use the card from your Medicare Advantage Plan to get your Medicare- covered services.
What are the marketing guidelines?
Content Marketing Guidelines are a set of instructions indicating tone, voice, length, style and topics on how your brand should communicate to your target audience. Let's go into why you need to make this document, even if you're a smaller business, and how to go about doing it.
What is Medicare solicitation?
Solicited Contact: This includes anyone who has given explicit permission for the agent to contact them or scheduled a Medicare sales appointment.Feb 28, 2019
What are the three main ways in which Medicare sales occur?
There are three different types of Medicare products sold by agents and brokers: Medicare Supplement plans (Also called Medigap plans), Medicare Advantage plans and Medicare Part D Rx plans. While some agents sell all three, others prefer to specialize in only one – either Medicare Advantage or Medicare Supplement.Mar 10, 2017
How long does a scope of appointment last?
ten yearsMedicare Scope of Appointment Form The Scope of Appointment is a requirement for in-person appointments. Agents must document their meetings with potential and current beneficiaries. The form goes on file for ten years and protects all parties.Sep 27, 2021
How long is an SOA valid for?
Q: How long do I have to keep SOA forms? A: All documentation must be maintained for the selling year plus 10 additional years. This includes initial and second SOA forms obtained at the same appointment and any SOA form obtained regardless of whether an appointment ends in an enrollment or not.May 1, 2018
Does permission to contact expire once contact is made?
When does PTC Expire? PTC expires once contact is made or 9 months after the date received for MA and PDP plans. However, PTC expires 90 days after the date received for consumers requesting information on Medicare supplement insurance products or is on the federal Do-Not-Call Registry.
What are the Medicare marketing guidelines?
The Marketing guidelines reflect CMS' interpretation of the marketing requirements and related provisions of the Medicare Advantage and Medicare Prescription Drug Benefit rules (Chapter 42 of the Code of Federal Regulations, Parts 422 and 423).
Can Medicare Advantage and Prescription Drug Plans use one document?
The guidelines allow organizations offering both Medicare Advantage and Prescription Drug Plans the ability to reference one document when developing marketing materials.
What is a written arrangement with CMS?
Any party that enters into a written arrangement, acceptable to CMS, with persons or entities involved with the MA benefit, below the level of the arrangement between an MA organization (or applicant) and a first tier entity. These written arrangements continue down to the level of the ultimate provider of both health and administrative services.
How long does Medicare last?
An individual who is aging into Medicare eligibility, typically the seven month period consisting of three months prior to the individual’s birth month, the individual’s birth month, and three months following the individual’s birth month.
What is marketing appointment?
Marketing appointments are individual appointments designed to steer or, attempt to steer, enrollees or potential enrollees toward a plan or limited number of plans. All individual appointments between an agent and a beneficiary are considered marketing/sales appointments regardless of the content discussed.
What is the Spanish version of Medicare?
Section 1140 of the Social Security Act The Spanish version of the Medicare Prescription Drug Benefit Program Mark may be used in place of the English language version on materials produced entirely in Spanish. The two (2)-color version is preferred, but the grayscale, black and negative versions may be used.
What is the penalty for misusing Medicare name and marks?
In general, it authorizes the Inspector General of DHHS to impose penalties on any person who misuses the term Medicare or other names associated with DHHS in a manner which the person knows or should know gives the false impression that DHHS has approved, endorsed, or authorized it. Offenders are subject to fines of up to $5,000 per violation or in the case of a broadcast or telecast violation, $25,000.
What is a third party marketing organization?
Third-party marketing organizations are entities such as a Field Marketing Organization (FMO), General Agent (GA), or similar type of organization that has been retained to sell or promote a Plan’s/Part D Sponsor’s Medicare products on the Plan’s/Part D Sponsor’s behalf either directly or through sales agents or a combination of both.
What is co-branding in Medicare?
Co-branding is defined as a relationship between two or more separate legal entities, one of which is an organization that sponsors a Medicare Plan. Co-branding is when a Plan/Part D sponsor displays the name(s) or brand(s) of the co-branding entity or entities on its materials to signify a business arrangement. Co-branding arrangements allow a Plan/Part D sponsor and its co-branding partner(s) to promote enrollment in the Plan. Co-branding relationships are entered into independent of the contract that the Plan/Part D sponsor has with CMS.
What is included in CMS marketing?
Excluded are materials that may meet the definition of marketing based on content, but don’t meet the intent requirements of marketing.
What does CMS mean when it says "if a potential enrollee provides permission to be contacted, the contact
CMS deleted the phrase: “If a potential enrollee provides permission to be contacted, the contact must be event-specific and may not be treated as open-ended permission for future contacts.” Now that this phrase is gone from the guidelines, it appears that if a potential enrollee grants permission to be contacted, that same permission can be used during different election periods. With CMS removing the phrase, the door is open to more extended permission to contact those eligible for Medicare.
What is the new word for SMC scripts?
That included those to be used by agents or brokers. The word “script” has been replaced by “talking points,” which indicates that the agents can now deliver a more improvised and interactive presentation.
Do email messages have to be approved?
Emails that are considered communication do not have to be submitted for approval. Text messaging and other forms of electronic direct messaging such as social media would fall under unsolicited contact and is still not permitted. Another change was made to marketing and sales events.
Can a CMS plan sponsor advertise outside of the county?
CMS removed the wording that stated Plan/Part D sponsors may only advertise in their defined service area. Advertising can now be done outside of the plan’s county. Open Enrollment Period (OEP) can now be defined and discussed on plan sponsors’ websites.
Can an agent hold more than one event back to back?
This suggests that agents can now do this at the end of educational events, and an agent can hold more than one event back-to-back. It’ll be easier for agents to set appointments and make sales related to these events. It is now required that access to applicable disclaimers be included on your website.
Does CMS have to be approved through email?
Any website CMS considered marketing must be submitted for review and approval through the Health Plan Management System (HPMS). Plans may now contact potential enrollees through email. This is in addition to ads and direct mail that were previously approved.
What is communications in healthcare?
Communications refers to all materials and activities that provide information to current and prospective enrollees. Marketing is now considered a subset of communications. But CMS tweaked the definition to focus on materials and activities meant to influence a beneficiary's decision about their healthcare coverage.
When is the CMS fall conference?
The Centers for Medicare & Medicaid Services (CMS) discussed its updated communications and marketing guidelines during its annual Medicare Advantage and Prescription Drug Plan fall conference on Sept. 6. In this article, we look at the most notable changes.
What is a pre-enrollment checklist?
Pre-enrollment checklists fall under the communications definition and must be provided to potential beneficiaries with the Summary of Benefits (SB) when the SB accompanies an enrollment form. Plans/Part D sponsors may remove portions of the checklist that aren’t applicable to a plan type or product.
What is a presentation slide CMS?
The presentation slides also include a peek into other changes under consideration at CMS. The agency is in the process of updating the Health Plan Management System marketing submission codes. CMS also plans to conduct retrospective reviews to monitor compliance with the new requirements. These reviews may include requests to submit marketing and communications materials.
What is marketing content?
Marketing’s content includes information about the plan’s benefit structure, cost sharing and measuring or ranking standards. However, it excludes materials that may include the content, but do not meet the definition of “intent.”. To meet the new definition of marketing, the material or activity must meet both the intent and content requirements. ...
Can you contact a Part D sponsor?
Plans/Part D sponsors may contact current enrollees and prospective ones via email if there is a process for beneficiaries to opt-out of the messages, so consumers can elect to no longer receive emails.
Can a plan compare itself to a competitor?
Plans can now compare themselves to competitors provided the information is factual. Any comparison to another Plan/Part D sponsor must be supported by fact, such as studies or statistical data, and can’t be misleading. Materials that include plan comparisons fall under the definition of marketing.