Materials used to market Medicare Advantage, and Part D plans (including but not limited to, letters, postcards, brochures, scripts, radio and television ads, billboards, banners, signs, yellow page ads, church bulletin ads, and websites) must follow the CMS Medicare Marketing Guidelines. Branded vs. Generic Marketing Materials
Full Answer
What kind of marketing materials are used for Medicare Advantage?
Materials used to market Medicare Advantage, and Part D plans (including but not limited to, letters, postcards, brochures, scripts, radio and television ads, billboards, banners, signs, yellow page ads, church bulletin ads, and websites) must follow the CMS Medicare Marketing Guidelines. What is considered branded marketing material for Medicare?
What is a Medicare Advantage plan?
Medicare Advantage Plans are another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare.
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
Where can I find pre-approved Medicare marketing materials or other materials?
Q. Where can I find pre-approved Medicare marketing mailers or other materials? A. Agents can find many pre-approved marketing materials, in fact, Agent Pipeline has had many approved through carriers and CMS for use. However, you have many other options and a variety of materials that can be used to market for the AEP.
Can you solicit Medicare Advantage prospects through email?
The only caveat: If you are initiating contact via email, you're required to include an opt-out opportunity. Direct unsolicited contact, such as text and direct messaging over social media, falls into the same category as unsolicited phone calls and door-to-door solicitation. This means it is not permitted.
What agency provides oversight for Medicare Advantage products?
The federal agency that oversees CMS, which administers programs for protecting the health of all Americans, including Medicare, the Marketplace, Medicaid, and the Children's Health Insurance Program (CHIP).
What are the negatives of a Medicare Advantage plan?
Medicare Advantage can become expensive if you're sick, due to uncovered copays. Additionally, a plan may offer only a limited network of doctors, which can interfere with a patient's choice. It's not easy to change to another plan. If you decide to switch to a Medigap policy, there often are lifetime penalties.
What must Medicare Advantage plans cover in their product design?
Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you're in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you're always covered for emergency and urgent care.
Who is the primary regulator for Medicare Advantage?
The private health plans are known as Medicare Advantage plans and are regulated and reimbursed by the federal government.
What does CMS stand for?
The Centers for Medicare & Medicaid Services, CMS, is part of the Department of Health and Human Services (HHS).
Why are Medicare Advantage plans being pushed so hard?
Advantage plans are heavily advertised because of how they are funded. These plans' premiums are low or nonexistent because Medicare pays the carrier whenever someone enrolls. It benefits insurance companies to encourage enrollment in Advantage plans because of the money they receive from Medicare.
What is the highest rated Medicare Advantage plan?
According to MoneyGeek's scoring system, the top-rated Medicare Advantage plans are Blue Cross Blue Shield for preferred provider organizations and UnitedHealthcare for health maintenance organizations.
Can you switch back to Medicare from 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.
What is the difference between Original Medicare and Medicare Advantage?
Original Medicare covers inpatient hospital and skilled nursing services – Part A - and doctor visits, outpatient services and some preventative care – Part B. Medicare Advantage plans cover all the above (Part A and Part B), and most plans also cover prescription drugs (Part D).
What is the difference between Medicare Supplement and Medicare Advantage plans?
Medicare Advantage and Medicare Supplement are different types of Medicare coverage. You cannot have both at the same time. Medicare Advantage bundles Part A and B often with Part D and other types of coverage. Medicare Supplement is additional coverage you can buy if you have Original Medicare Part A and B.
What must all Medicare Advantage sponsors have in place in order to meet 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.
What is an HMO plan?
Health Maintenance Organization (HMO) plan is a type of Medicare Advantage Plan that generally provides health care coverage from doctors, other health care providers, or hospitals in the plan’s network (except emergency care, out-of-area urgent care, or out-of-area dialysis). A network is a group of doctors, hospitals, and medical facilities that contract with a plan to provide services. Most HMOs also require you to get a referral from your primary care doctor for specialist care, so that your care is coordinated.
What is a special needs plan?
Special Needs Plan (SNP) provides benefits and services to people with specific diseases, certain health care needs, or limited incomes. SNPs tailor their benefits, provider choices, and list of covered drugs (formularies) to best meet the specific needs of the groups they serve.
Do providers have to follow the terms and conditions of a health insurance plan?
The provider must follow the plan’s terms and conditions for payment, and bill the plan for the services they provide for you. However, the provider can decide at every visit whether to accept the plan and agree to treat you.
Can a provider bill you for PFFS?
The provider shouldn’t provide services to you except in emergencies, and you’ll need to find another provider that will accept the PFFS plan .However, if the provider chooses to treat you, then they can only bill you for plan-allowed cost sharing. They must bill the plan for your covered services. You’re only required to pay the copayment or coinsurance the plan allows for the types of services you get at the time of the service. You may have to pay an additional amount (up to 15% more) if the plan allows providers to “balance bill” (when a provider bills you for the difference between the provider’s charge and the allowed amount).
CMS Model Marketing Materials
View the model marketing materials in the Downloads section below. 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.
Part C Explanation of Benefits (EOB) Materials
View the Part C EOB materials in the Downloads section below.
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 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.
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 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.
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.
Do sponsors have to enter co-branding in HPMS?
Plans/Part D Sponsors must enter in HPMS any co-branding relationships, including any changes in or newly formed co-branding relationships, prior to marketing it. Plans/Part D Sponsors should reference the HPMS Bid User’s Manual for instructions on entering co-branding information (see section
What materials are used to market Medicare Advantage?
Materials used to market Medicare Advantage, and Part D plans (including but not limited to, letters, postcards, brochures, scripts, radio and television ads, billboards, banners, signs, yellow page ads, church bulletin ads, ...
What is generic marketing material for Medicare?
What is considered generic marketing material for Medicare? Generic material, by MMG definition, is any marketing material that is free of the plan or product information, brands or carrier logos. These types of pieces do not need to be approved but must comply with CMS guidelines.
Does Agent Pipeline have Medicare?
Agent Pipeline has several pre-approved Medicare marketing mailers, flyers, postcards, business-reply-cards and other materials available for our agents to use. You can also customize many carrier pieces by visiting their Agent Portal. If you need more information on customizing your materials, submitting them for approval, ...
