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marketing non-health related items to medicare beneficiaries what is the requirement

by Kory Conn Published 2 years ago Updated 1 year ago

You cannot market nonhealth-related plans to prospective enrollees while conducting a sale for a Medicare Advantage (MA) or Medicare Part D plan—these are among the health products that CMS regulates.

Full Answer

What are the marketing guidelines for Medicare Advantage?

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).

What are Medicare marketing materials?

Marketing materials are any materials developed and or distributed by entities covered by the Medicare Marketing Guidelines (MMG) and are targeted to Medicare beneficiaries. The following pages outline the types of materials considered to be marketing materials and examples from section 10 of the MMG. Definition of Medicare Marketing Materials 5

Who is bound by Medicare marketing guidelines and Health Net policies?

Health Net's contracted and delegated entities, providers and vendors are bound by the Medicare Marketing Guidelines and Health Net policies as part of their contract with Health Net.

When is a health plan’s communication not marketing?

A health plan sends a mailing to subscribers approaching Medicare eligible age with materials describing its Medicare supplemental plan and an application form. (2) A communication is not “marketing” if it is made for treatment of the individual. For example, under this exception, it is not “marketing” when:

What is considered marketing material by CMS?

CMS Model Marketing Materials Model marketing materials include: the standardized Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) templates and instructions, ANOC/EOC Errata, and Provider Directory.

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.

What are some of the unique rules for marketing and selling Medicare plans?

Medicare has rules for how plans can contact you in different situations: By mail, radio, and print advertisements: Plans are allowed to market themselves by any of these means. They cannot, in these advertisements or in any other marketing situation, suggest that they are endorsed or preferred by Medicare.

Which of the following areas is the marketing of Medicare health plans prohibited?

Participating in any marketing activity—such as distributing and accepting enrollment applications, conducting sales presentations, and soliciting beneficiaries—is not allowed in areas where individuals receive or wait to receive healthcare service. These areas include: Exam rooms.

What are the marketing guidelines?

So, here are some very basic, simple rules of marketing which I think we can ALL benefit from.Rule #1: Make Yourself Known. ... Rule #2: Taking The Competition Seriously. ... Rule #3: Relate To Your Audience. ... Rule #4: Progress At The Speed Of The Audience. ... Rule #5: Making Your Customers Happy. ... Final Thoughts.

How do I advertise with Medicare?

⍟ 14 Ways to Generate Medicare Supplement LeadsBuild & Maintain a Website. ... Social Media Presence. ... Video Marketing. ... Blogging, Writing Articles. ... Email. ... Online Events: Live webinars, podcasts. ... Direct Requests / Client Referrals. ... Lead Swapping Partnerships (Asking other professionals for referrals)More items...

Can you text Medicare beneficiaries?

Do Not engage in telephone solicitations, including voice mails or text messages. Do Not approach and solicit Medicare Beneficiaries in common/ public areas.

Which of the following must you not do when marketing UnitedHealthcare Medicare Advantage or prescription drug plans to consumers?

As an agent, you must not do which of the following when marketing UnitedHealthcare Medicare Advantage plans to consumers? Use providers or provider groups to distribute printed information comparing benefits of different health plans without approval.

What are the Medicare regulations?

Medicare Regulations means, collectively, all Federal statutes (whether set forth in Title XVIII of the Social Security Act or elsewhere) affecting the health insurance program for the aged and disabled established by Title XVIII of the Social Security Act (42 U.S.C.

What actions are prohibited during marketing sales events?

Cannot send unsolicited text messages and leave voicemail messages. May call or visit beneficiaries who attended a marketing/sales event prior permission is given and documented. Cannot approach beneficiaries in common areas (i.e. parking lots, hallways, lobbies, sidewalks).

What must all Medicare Advantage sponsors have in place in order to meet CMS compliance 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.

What is considered unsolicited contact with a Medicare eligible consumer?

Unsolicited direct contact with a consumer that was not requested or initiated by the consumer is prohibited and includes in-person (e.g., door-to-door marketing), telephonic (e.g., outbound telemarketing), electronic (e.g., email, voicemail messages, text messages) solicitation.

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 Medicare marketing guidelines?

The Medicare Marketing Guidelines (MMG) implement the Centers for Medicare & Medicaid Services’ (CMS) marketing requirements and related provisions of the Medicare Advantage (MA, MA-PD ) (also referred to as Plan), Medicare Prescription Drug Plan (PDP) (also referred to as Part D Sponsor), and except where otherwise specified, Section 1876 cost plans (also referred to as Plan) rules, (i.e., Title 42 of the Code of Federal Regulations, Parts 422, 423, and 417). These requirements also apply to Medicare-Medicaid Plans (MMPs), except as modified or clarified in state-specific marketing guidance for each state’s demonstration. State-specific guidance is considered an addendum to the MMG. State-specific marketing guidance for MMPs will be posted to http://www.cms.gov/Medicare-

What is a non-benefit/non-health service provider?

Third parties that provide non-benefit/non-health services (“Non-benefit/non-health service providing third party entities”) are organizations or individuals that supply non-benefit related information to Medicare beneficiaries or a Plan’s/Part D Sponsor’s membership, which is paid for by the Plan/Part D Sponsor or the non-benefit/non-health service-providing third-party entity.

How long does it take to review marketing materials in HPMS?

Based on the material type, and as indicated by HPMS, marketing materials submitted in HPMS for prospective review will have a review timeframe of 10 or 45 days. The marketing review time period begins on the date a material is submitted in HPMS.

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 a script in Medicare?

Informational scripts are designed to respond to beneficiary questions and requests and provide objective information about a plan or the Medicare program. Sales and enrollment scripts are intended to steer a beneficiary towards a plan or limited number of plans, or to enroll a beneficiary into a plan.

What is an educational event for Medicare?

Educational events are designed to inform Medicare beneficiaries about Medicare Advantage, Prescription Drug or other Medicare programs and do not include marketing (i.e., the event sponsor does not steer, or attempt to steer, potential enrollees toward a specific plan or limited number of plans).

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 marketing 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.

Can you send marketing materials to Medicare?

You can send current Medicare enrollees marketing materials about other health-related lines of business as long as these requirements are met: You include instructions on how to opt out of receiving such communications. You must make sure that individuals who ask to opt-out are not sent future communications about health products ...

Can you market a Medicare Advantage plan?

You can market health-related plans to prospective enrollees while conducting a sale for Medicare Advantage or a Medicare Part D plan, provided that the information is being requested on the Scope of Appointment .

What is not marketing in Medicare?

A health plan sends a mailing to subscribers approaching Medicare eligible age with materials describing its Medicare supplemental plan and an application form. (2) A communication is not “marketing” if it is made for treatment of the individual. For example, under this exception, it is not “marketing” when:

What is marketing in health plans?

For example, it is “marketing” when: A health plan sells a list of its members to a company that sells blood glucose monitors, which intends to send the plan’s members brochures on the benefits of purchasing and using the monitors.

What is the HIPAA Privacy Rule?

The HIPAA Privacy Rule gives individuals important controls over whether and how their protected health information is used and disclosed for marketing purposes. With limited exceptions, the Rule requires an individual’s written authorization before a use or disclosure of his or her protected health information can be made for marketing.

What are some examples of marketing communications?

Examples of “marketing” communications requiring prior authorization are: A communication from a hospital informing former patients about a cardiac facility, that is not part of the hospital, that can provide a baseline EKG for $39, when the communication is not for the purpose of providing treatment advice.

What is health related product?

Health-related products or services available only to a health plan enrollee that add value to, but are not part of, a plan of benefits. This exception to the marketing definition permits communications by a covered entity about its own products or services.

What is a primary care physician?

A primary care physician refers an individual to a specialist for a follow-up test or provides free samples of a prescription drug to a patient.

Do you need a business associate's authorization to use protected health information?

Marketing Authorizations and When Authorizations are NOT Necessary.

What is marketing material?

Marketing materials contain some plan-specific information, such as benefits, premiums, and comparisons to other plans. Marketing materials are subject to CMS review, whereas non-marketing materials are not. During presentations, you should never attempt to mislead your clients, willingly or unwillingly.

Can an agent hold a sales event immediately following an educational event?

Agents are now permitted to schedule and hold a sales event immediately following an educational event. The attendees must be made aware of a change from educational event to marketing event and given the opportunity to leave prior to the event beginning.

Can agents improvise their presentation?

Additionally, agents are allowed to improvise their delivery of the presentation and content they’d like to cover before accepting an application at a sales appointment. Now only “talking points” need to be submitted to CMS by the carriers, allowing agents the freedom to conduct a more interactive sales presentation.

Can an agent contact potential clients via email?

Due to a change reflected in the 2019 Medicare Communications and Marketing Guidelines (MCMG) and now updated in CFR 42, agents are permitted to make unsolicited direct contact with potential enrollees via email. However, the email must have an opt-out option in order to remain compliant. Additionally, the content of any unsolicited email cannot intend to steer a recipient into choosing or retaining a plan. A compliant email would promote your services rather than any specific plans.

What Are Health-Related Plans?

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Health-related lines of business vary but can include: 1. Medicare Supplements (Medigap) 2. Supplemental plans for cancer, hospital indemnity, and/or long-term care (LTC) 3. Dental insurance 4. Vision policies
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When Can I Market Other Health-Related Plans to Prospective Enrollees?

  • You cannot market nonhealth-related plans to prospective enrollees while conducting a sale for a Medicare Advantage (MA) or Medicare Part D plan—these are among the health products that CMS regulates. You can market health-related plans to prospective enrollees while conducting a sale for Medicare Advantage or a Medicare Part D plan, provided that the information is being re…
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How Can I Market Other Health-Related Plans to Current Enrollees?

  • You can send current Medicare enrollees marketing materials about other health-related lines of business as long as these requirements are met: 1. You include instructions on how to opt out of receiving such communications. You must make sure that individuals who ask to opt-out are not sent future communications about health products that are not r...
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Cross-Selling Other Health-Related Products

  • Knowing how to compliantly cross-sell other health-related products to Medicare beneficiaries can be the key to keeping your business profitable. Excelsior’s exclusive and low-cost lead program offers more opportunities to cross-sell to the right prospects.* Join Excelsiortoday, and get access to a senior Medicare expert. Note: For the most current information, see the CMS Me…
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