What are the new Medicare marketing rules?
While Medicare Advantage “plans” are specific benefit packages offered by a Medicare Advantage “organization,” in this chapter, “plan” is used both to refer to the MA plan and to the MA organization offering the
Where can I find pre-approved Medicare marketing materials or other materials?
40.1 – Marketing Material Identification .....13. 1. While Medicare Advantage “plans” are specific benefit packages offered by a Medicare Advantage “organization,” in this chapter, “plan” is used both to refer to the MA plan and to the MA organization offering the plan.
Does CMS have to approve generic marketing material for Medicare?
The Medicare Marketing Guidelines (MMG) implement the Centers for Medicare & Medicaid Services’ (CMS) marketing requirements and related provisions of the Medicare Advantage (MA) (also referred to as Plan), Medicare Prescription Drug Plan (PDP) (also referred to as Part D Sponsor), and except where otherwise
Can a broker market during the Medicare open enrollment period?
Aug 15, 2005 · People with Medicare can begin to enroll in the program on November 15, 2005 while plans can begin to market their packages on October 1, 2005. The marketing guidelines issued today will: Protect beneficiaries’ rights and privacy
When can Medicare marketing begin?
For people who are eligible for Medicare, the Initial Enrollment Period begins three months before their 65th birthday, includes their birthday month, and ends three months after their birthday, making their IEP a 7-month time period.Jun 23, 2021
What is Medicare solicitation?
Come to your home uninvited to sell or endorse anything. Call you unless you're already a member of the plan. If you're a member, the agent who helped you join can call you. Require you to speak to a sales agent to get information about the plan.
Who approves Medicare marketing materials?
What is considered marketing material by CMS?
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 are the changes to Medicare in 2021?
What does Stark law prohibit?
What are CMS guidelines for referrals?
What are the guidelines of marketing?
- Rule #1: Make Yourself Known. People are only going to do business with people they trust. ...
- 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.
Can you email Medicare prospects?
Which of the following must you not do when marketing UnitedHealthcare Medicare Advantage?
When can telephonic contact with a Medicare eligible consumer be made?
What are the 3 main ways in which Medicare sales occur?
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 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 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.
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 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.
What is a Part D sponsor?
Plans/Part D Sponsors must ensure that materials developed by a third-party providing information on a subset of plan choices that lists, compares, or names available plans, must prominently display the following disclaimer on all 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 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
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 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 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.
What is a Part D sponsor?
Plans/Part D Sponsors must ensure that materials developed by a third party providing information on a subset of plan choices that lists, compares, or names available plans, must prominently display the following disclaimer on all materials:
How much notice do you need to give to a Part D sponsor?
Part D Sponsors must provide at least sixty (60) days’ notice or a 60-day supply with notice to affected enrollees before removing a Part D drug from the Part D Sponsor’s formulary (e.g., adding prior authorization, quantity limits, step therapy or other restrictions on a drug), or moving a drug to a higher cost-sharing tier. A sixty (60) day notice must be provided in writing unless a beneficiary has affirmatively elected to receive electronic notice. Part D Sponsors should refer to Chapter 6 of the Prescription Drug Manual,
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) (also referred to as Plan), Medicare Prescription Drug Plan (PDP) (also referred to as Part D Sponsor), and except where otherwise specified 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 do not apply to Program of All-Inclusive Care for the Elderly (PACE) plans or section 1833 Health Care Pre-payment Plans. 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
When do Part D sponsors receive EOB?
Part D Sponsors must ensure that enrollees who utilize their prescription drug benefits in a given month receive their Explanation of Benefits (EOB) by the end of the month following the month in which they utilized their prescription drug benefits.
What is 422.2268 E-F?
42 CFR 422.2268(e-f), 423.2268(e-f) Plan/Part D Sponsor marketing materials sent to current enrollees describing other health-related lines of business are expected to contain instructions that describe how individuals may opt out of receiving such communications. Plans/Part D Sponsors must ensure individuals (including non-enrollees) who ask to opt out of receiving future marketing communications are not sent such communications. In marketing multiple lines of business, Plans/Part D Sponsors must comply with the Health Insurance Portability and Accountability Act (HIPAA) rules (outlined generally in Appendix 2) and the guidance in section 160 regarding use of beneficiary information.
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.
What is a Part D sponsor?
“[Plan’s/Part D Sponsor’s legal or marketing name] is an HMO plan with a Medicare contract. Enrollment in [Plan’s/Part D Sponsor’s legal or marketing name] depends on contract renewal.”
What is promotional activity?
Generally, promotional activities are designed to attract the attention of prospective enrollees and/or encourage retention of current enrollees. In addition to the guidance on nominal gifts, any promotional activities or items offered by Plans/Part D Sponsors:
How to make continuing affiliation announcement?
Continuing affiliation announcements may be made through direct mail, e-mail, phone or advertisement. Continuing affiliation announcements must clearly state that the provider may also contract with other Plans/Part D Sponsors.
How to market Medicare Advantage?
These final guidelines reflect the input, feedback and recommendations that consumer and industry groups provided on earlier draft guidelines. The guidelines released today improve on the draft guidelines in a few specific areas: 1 Combining the updated Medicare Advantage marketing guidelines with the new guidelines for the Medicare prescription drug plans so that there is a single reference document for plans that offer both. 2 Outlining the roles of independent agents and brokers; 3 Providing parameters where plans may “co-brand” with other organizations; 4 Allowing plans that demonstrate consistent adherence to the guidelines to “file and use” submitted materials, based on well-established practices from the FEHBP program; 5 Requiring plans to follow the federal “do not call” requirements and all other federal and state requirements for telemarketing, to protect beneficiaries from unwanted or improper calls from plans; and 6 Providing details on what types of promotional activities plans may employ.
Can Medicare Advantage plans make door to door calls?
The marketing guidelines prohibit Medicare Advantage plans, PDPs or their representatives from making door-to-door sales calls or sending unsolicited e-mails. If plans use brokers or independent agents, those individuals must adhere to state licensing requirements. Plans that employ marketing representatives must ensure that those representatives meet all state requirements, including state licensure and certification or registration.
Who can provide information about Medicare?
Many people with Medicare rely on their neighborhood pharmacists and other health care providers for information about their prescription drugs and coverage. Physicians, pharmacists and other health care professionals can provide objective information regarding specific plans, covered benefits, cost sharing, drugs on formularies ...
What is a Medicare file and use certification?
File and Use certification allows plans to submit and certify that certain types of materials meet CMS marketing guidelines. Medicare Advantage plans must provide this information to CMS at least five days before they begin to be used. Under the File and Use certification, plans may be able to use CMS-provided “model language” for certain marketing materials, as long as the model language is not modified. Activities such as advertising are included under File and Use Certification and provide assurances to beneficiaries that the information they receive is consistent across plans.
How to protect against fraud?
To protect against fraud or unwanted solicitations, consumers should be aware that: 1 They should not give out personal information (e.g., Social Security Numbers, bank account numbers, credit card numbers, etc.) to plan marketing representatives, because plans are not allowed to request such personal information in their marketing activities. 2 Plans cannot call outside of the calling hours allowed by the federal government and states. Federal rules do not allow telemarketers to call before 8 a.m. or after 9 p.m. State rules may vary. 3 To stop repeated and unwanted sales calls, beneficiaries simply need to say “stop:” plans are required to honor “do not call again” requests from beneficiaries. To register for the federal “do not call” list to prevent all unsolicited marketing calls, go to www.donotcall.gov. 4 Additional information about drug plan options from an independent source, beneficiaries can go to www.medicare.gov, call 1-800-MEDICARE, or seek help from the local State Health Insurance Assistance Program or Area Agency on Aging to get personalized information about which drug plan may be best for them.
What are the Medicare marketing guidelines for 2019?
The Medicare Marketing Guidelines for 2019 have loosened the rules around unsolicited contact. Sections 30.6 and 40.2 allow brokers to initiate contact via email, conventional mail, and print media. This includes communication and marketing for sales and retention.
What is CMS review?
CMS conducts prospective and retrospective reviews of marketing materials . These include, but are not limited to, accepted (File &Use) materials, approved materials, documents in the marketplace, as well as materials associated with marketing activities.
What is content in marketing?
Content – based on the exclusions in the definition of marketing and marketing materials and the type of information that would be intended to draw attention to a plan or influence a beneficiary’s enrollment decision, marketing activities and materials include: Information about benefits or benefits structure;
What is MMG 90.9?
The updated MMG has revised this subsection’s language to: 1) describe the review process as including prospective and retrospective marketing materials, 2) increase the listed review materials, and 3) detail the potential action needed from Plan/Part D Sponsors if errors are found. The new language reads:
What is 120.4.4?
120.4.4: Payments Other Than Compensation. The language update in this subsection is only reflected in the notes. The clarification references how items paid for outside of compensation must be paid at fair market value and outside of enrollment numbers. The subsection and new note language read:
Is There a Limit to the Value of the Gift?
Yes. A gift for a current or prospective enrollee cannot exceed a fair market value of $15, according to the Medicare Marketing Guidelines, Section 40.4. For example, you could hand out one of these items as a gift, as long as they are priced at $15 or less:
Is There a Limit to the Amount of Gifts a Person can Receive?
Yes. One person cannot receive more than the value of $75 per year. Brokers are not required to track promotional items per person, but you can’t intentionally plan to give anyone more than $75 per year.
Can the Gift be in Cash?
No. Gifts cannot be in the form of cash or other monetary rebates. This is true even if the worth of the cash gift is less than or equal to $15. Gift cards are a gray area for the Medicare Marketing Guidelines. While it may be easiest to avoid them, the Office of Inspector General’s website has given some advice and leeway in specific situations.
Can Brokers Select Which Medicare Enrollees will get a Gift?
No. Gifts must be offered to all potential enrollees, whether they purchase a plan or not, without discrimination.
Can Brokers Offer Free Medical Checkups or Discounted Medication as Gifts?
No. You cannot offer anything that is considered a drug or health benefit. Similarly, you cannot offer a gift that is connected directly or indirectly to the provision of any other covered item or service.
Where can I get More Medicare Marketing Guidance?
Excelsior’s resource center offers more MMG-centered topics ranging from event-specific contact to proper venues for educational events. Our resource center is available 24/7 to give you the help you need with Medicare guidelines, sales advice, and more to keep your business on track.
What Statements Do Brokers Need for Direct Mail?
One of the following disclaimers must be prominently displayed on any direct mail sent to prospective or current beneficiaries.
What Statements Do Brokers Need for Email?
CMS requires certain disclaimers for emails sent to potential Medicare beneficiaries.
Grow Your Business With Excelsior
Excelsior offers brokers offers insight through our resource center, where we break down other MMG topics ranging from mailings for multiple lines of business to disclaimers on marketing materials. As a broker, you are your own small business. We want to help you grow that business.