Marketing materials are communication materials (any format) targeted to Medicare beneficiaries that promote or mention plan sponsor names, brand names, plan names, logos, plan benefits, coverage or features of any of plans. Educational materialsare communication materials that inform a beneficiary about Original Medicare, Medicare Advantage or Medicare Part D in an unbiased way that does not steer, or attempt to steer, that enrollee toward a specific plan or group of plans. Health education materials are communication materials that promote general health, health education, or disease management, but do not include any specific plan-related information.
Full Answer
What are the Medicare communications and marketing guidelines?
The Medicare Communications and Marketing Guidelines (MCMG) interprets and provides 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
What communication materials are excluded from CMS’s material ID requirement?
Please note that agent-developed communication materials that are not marketing are excluded from CMS’s material ID requirement. According to the MCMG, agents are permitted to make unsolicited direct contact with potential enrollees through conventional mail and other print media, such as advertisements or direct mail.
What are the new MCMG materials categories?
Materials will now be classified into two sections: communications and marketing. The new MCMG defines communications as “activities and use of materials to provide information to current and prospective enrollees,” making it the more general of the two. Materials that fall under this category are not subject to review by CMS.
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.
What does CMS define as a communications?
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.
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.
What are CMS guidelines for referrals?
In a CMS compliant situation, you would 1) ask for referrals without mentioning any benefit to the enrollee and then 2) present a thank-you gift for the referrals he or she has provided. Second, the gifts you provide must be of a nominal value.
How do I communicate with Medicare?
Call 1-800-MEDICARE For questions about your claims or other personal Medicare information, log into (or create) your secure Medicare account, or call us at 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
What is considered unsolicited contact?
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.
Can you sell Medicare door to door?
MA/PD PLANS May not market to beneficiaries door to door, including leaving materials at a beneficiary's doorstep. May call a beneficiary they enrolled in a plan to discuss plan business, as well as discuss the availability of other plan options/types within the same parent organization.
Can Medicare agents cold call?
Insurance agents are not allowed to make cold calls to solicit business, so agents sometimes engage outside marketers to call Medicare beneficiaries and promise to put them into “a better” plan.
Can you cold call Medicare?
CMS has strict guidelines around contacting Medicare beneficiaries. In general, you can't market through unsolicited direct contact. (Often referred to as cold calling and includes going door-to-door.) Referred beneficiaries must contact you or the plan directly.
What is the difference between a referral and a pre authorization?
A referral is an order from your PCP to see a specialist or receive certain medical services from some providers. Your PCP helps make the decision about whether specialist services are necessary for you. Prior authorization is approval from the health plan before you get a service or fill a prescription.
Can Medicare agents ask for referrals?
As a Medicare sales agent, you can ask for referrals, but you cannot collect phone numbers. Instead, you can ask your clients to refer you to their family members and friends. Just give your original client a few of your business cards and tell them that anyone who they meet and needs help, can contact you.
What is authorization and referral?
Utilizing our referral and pre-authorization services confirms that the patient is approved for the planned service or procedure prior to arrival, ensuring that the first stage of the revenue cycle is completed accurately. Doing so sets the rest of the claims process up for success.
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 MCMG in Medicare?
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 as “Part D sponsors”), and except where otherwise specified, Section 1876 cost plans (also referred to as “plans”) and employer/union-sponsored group MA or Part D plans. These plans are governed under Title 42 of the Code of Federal Regulations (CFR), 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. Such state-specific guidance for MMPs is considered an addendum to the MCMG, and will be posted to:
What is enrollment material?
Enrollment materials are materials used to enroll or disenroll a beneficiary from a plan, or materials used to convey information specific to enrollment and disenrollment issues such as enrollment and disenrollment notices.
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.
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.
Do you have to insert prior year Medicare premiums?
Plans that use Medicare premium, deductible, or cost sharing amounts (e.g., inpatient hospital) must insert the prior year’s Medicare amounts. In addition, the benefit category must also note that these amounts may change for the following year and the plan will provide updated rates as soon as Medicare releases them.
How does CMS determine the category?
CMS determines the category that the material falls into by reviewing both the content and the intent of the piece. What does it say and what is your intention? Let’s look at an example from the MCMG:
What is marketing materials?
Marketing, however, is a subset of communications. These materials are often more specific and provide detailed information. The purpose of these materials is to draw a beneficiary’s attention to a certain plan and influence their decision. These pieces could potentially include information on the plan’s benefit structure, cost sharing, and measuring or ranking standards. Marketing materials are subject to CMS review.
Is agent developed communication material a CMS material ID?
Please note that agent-developed communication materials that are not marketing are excluded from CMS’s material ID requirement.
Can you send marketing materials to a beneficiary?
You are allowed to send marketing materials and hold one-on-one meetings , but only at the request of the beneficiary.
Is the advertisement considered marketing or communications?
Would this be considered communications or marketing? Because the advertisement includes both the intent to draw the reader’s attention to the plan and mentions that $0 premiums are available, this would fall under the marketing category.
Can agents make unsolicited direct contact with enrollees?
According to the MCMG, agents are permitted to make unsolicited direct contact with potential enrollees through conventional mail and other print media, such as advertisements or direct mail.
Communications vs. Marketing
- Formally known as the Medicare Marketing Guidelines (MMG), CMS’ regulations are now named the Medicare Communications and Marketing Guidelines (MCMG). One of the biggest changes in the new guidelines is how marketing materials are categorized. In the past, all marketing materials were subject to review by CMS. This year, there’s a little more leewa...
Contact Via Email
- According to the MCMG, agents are permitted to make unsolicited direct contact with potential enrollees through conventional mail and other print media, such as advertisements or direct mail. Additionally, agents can make unsolicited direct contact with beneficiaries via email. However, in order to remain compliant, your email must contain an “opt out” function. You would need to utili…
Reinstatement of The Open Enrollment Period
- The Medicare Advantage Disenrollment Period (MADP) which would normally take place from January 1 through February 14 is being replaced with the Medicare Advantage Open Enrollment Period (OEP). The new OEP will occur between January 1 and March 31 annually beginning in 2019. During this time, clients who are enrolled in a Medicare Advantage plan (and those who ar…