Medicare private plans are allowed to conduct certain activities. For instance, companies can market their plans through direct mail, radio, television, and print advertisements. Plans can also send emails, but they must provide an opt-out option in the email for people who do not wish to receive them.
Full Answer
Can a Medicare Advantage Marketing Plan work for You?
Medicare private plans are allowed to conduct certain activities. For instance, companies can market their plan through direct mail, radio, television, and print advertisements. Agents can also visit your home if you invite them for a marketing appointment. However, insurance agents cannot: Call you if you did not give them permission to do so
What are Medicare private plans’ marketing rules?
Medicare Marketing Guidelines . For Medicare Advantage Plans. 1, Medicare Advantage Prescription Drug Plans, Prescription Drug Plans, Employer/Union-Sponsored Group Health Plans, Medicare -Medicaid Plans, and Section 1876 Cost Plans. Table of Contents (Issued: 06/10/2016)
What do the new guidelines mean for Medicare Advantage Marketing materials?
Sep 17, 2019 · This is also known as marketing fraud. Medicare private plans are allowed to conduct certain activities. For instance, companies can market their plans through direct mail, radio, television, and print advertisements. Plans can also send emails, but they must provide an opt-out option in the email for people who do not wish to receive them.
What are the Medicare marketing guidelines for sponsors?
Aug 15, 2005 · 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.
What can plan sponsors market to current Medicare Advantage plan members?
CMS uses the term “plan sponsor” to describe an organization that has an approved, active contract with the federal government to offer Medicare Advantage plans, prescription drug plans, and 1876 cost plans. A plan sponsor can be an employer, a union, or a health insurance carrier.Oct 19, 2017
How do you market Medicare products?
⍟ 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 market Medicare Advantage via email?
Due to a change reflected in the 2019 MCMG and now in the Medicare Advantage & Part D Communication Requirements, 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.Sep 9, 2021
Which of the following is an allowable form of contact for prospecting Medicare Advantage clients?
Brokers Can Now Initiate Unsolicited Contact Through Email. 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.Oct 19, 2018
Which of the following must you not do when marketing UnitedHealthcare Medicare Advantage?
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 3 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
When marketing UnitedHealthcare Medicare Advantage plans to consumers which of the following must an agent do?
The individual must be legally authorized in the state in which the consumer resides to act on behalf of the consumer (e.g., Power of Attorney). Advantage plans to consumers, which of the following must an agent do? Provide current marketing materials that have been approved by CMS and UnitedHealthcare.
What are 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.
How CMS define marketing?
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.”Sep 20, 2018
What is Medicare permission to contact guidelines?
What Does it Cover? 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
What is Medicare compliance?
The Medicare Compliance Program is specifically designed to prevent, detect, and correct noncompliance as well as fraud, waste, and abuse.
What is Medicare regulation?
Medicare Regulations means, collectively, all federal statutes (whether set forth in Title XVIII of the Social Security Act or elsewhere) affecting Medicare, together with all applicable provisions of all rules, regulations, manuals and orders and administrative, reimbursement and other guidelines having the force of ...
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 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.
What is Ad hoc enrollment?
Ad hoc enrollee communication materials are informational materials that are targeted to current enrollees, are customized or limited to a subset of enrollees, apply to a specific situation or cover enrollee-specific claims processing or other operational issues, and do not include information about the plan’s benefit structure. In addition, these communication materials are not tied to regularly occurring events such as aging into Medicare, the Annual Enrollment Period, or a new contract year. These materials are not considered marketing materials. Examples include, but are not limited to, the following:
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 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 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 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.
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.
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.
What is Medicare Advantage Marketing Plan?
A Medicare Advantage marketing plan allows you to reach patients at all stages of the process, but it can be tricky to do effectively and ethically.
What is Medicare Advantage?
On the wrong plan, patients may end up refusing treatment or seeking alternative treatments to avoid paying tens of thousands of dollars, but Medicare Advantage (also known as Part C coverage) helps them avoid this. Patients are still covered by Medicare Part A (hospital insurance) and Part B (medical insurance), ...
Why do people choose Medicare Advantage?
That’s why millions of people choose a private Medicare Advantage plan as their 65th birthday approaches or during the Annual Election Period (also known as AEP or open enrollment)—to fill in those gaps and prevent a major procedure from leading to bankruptcy. A Medicare Advantage marketing plan allows you to reach patients at all stages ...
Does Medicare have gaps?
Unfortunately, original Medicare can have gaps in coverage that steer people away from making the right decisions for their health.
Does Medicare cover out of pocket fees?
Patients are still covered by Medicare Part A (hospital insurance) and Part B (medical insurance), but with additional benefits original Medicare won’t cover. Out-of-pocket fees are limited annually as well . Give patients who ask about Medicare a safe place to go.
Do providers need to remain neutral about Medicare?
Providers do need to remain neutral about most aspects of choosing a Medicare plan. Still, you can and should keep patients informed of all their options and ensure they are able to make the right decisions for their health. There are plenty of ways to reach out to patients who may be considering a Medicare Advantage plan:
Can seniors use social media?
However, with the right plan in place, you can reach future patients through…. Remember, many seniors have family members making their healthcare decisions, so don’t rule out digital and social media advertising as a way to reach those decision-makers.
What is marketing misconduct in Medicare Advantage?
Marketing misconduct surrounding the sale of Medicare Advantage plans has received growing attention from the public, the advocacy community, the media and Congress. Over the last several months, CMS has issued the 2008 Call Letter to MA and Part D plans which proposed some new requirements relating to the marketing of PFFS plans (5), and in late May released new guidance for PFFS plans, some to be implemented immediately and some before the start of the next Annual Election Period (AEP). Recent CMS activity surrounding marketing abuse culminated on June 15th, 2007, when CMS held a press conference announcing that in response to concerns about marketing practices seven insurance companies signed an agreement to suspend voluntarily the marketing of their Private-Fee-for-Service (PFFS) products. (6) CMS stated that the suspension for a given plan will be lifted only when CMS certifies that the plan has systems and management controls in place to meet all of the conditions outlined in CMS’s 2008 Call Letter and the May 25th Guidance.
What are the factors that drive inappropriate sales of certain plans?
One of the primary forces driving inappropriate sales of certain plans, we believe, is profit: 1) the high payments that Medicare Advantage plans receive (particularly PFFS plans) (10); and 2) the varying commissions that plans can pay agents selling Medicare products. The current commission structure employed by most (if not all) plans – and allowed by CMS – permits marketing agents to steer consumers to plans that generate higher commissions as well as revenues for the company, regardless of whether such products are the most suitable choice for an individual consumer. We have found that it is not uncommon for insurance companies to pay up to five times the commission for a Medicare Advantage enrollment versus a stand alone Part D prescription drug plan (PDP) enrollment. (11)
What is Medicare Modernization Act?
The Medicare Modernization Act injected new incentives for private companies to offer a range of new products to Medicare beneficiaries, greatly increasing the number and types of plans available, all of which have significant flexibility to design their benefits and cost-sharing structures. When choosing how to obtain coverage through Medicare, an individual has a range of variables s/he must consider, based upon any current coverage s/he might have. As consumers struggle to find the best combination of prescription drug and medical benefits for their individual needs, they must navigate a dizzying array of configurations and cost-sharing arrangements available through Original Medicare, Medicare supplemental insurance plans (Medigaps), Medicare Advantage (MA) plans, and retiree or other coverage. There are multiple variations between and among these different options. Some individuals are eligible for both Medicare and Medicaid, or some other program that can help pay for some or all of their costs.
What are the victims of marketing abuse?
Many victims of marketing abuse who are enrolled in plans that they did not want do not know where to turn. Many Medicare beneficiaries are unaware of both their rights and their ability to get help from SHIP programs and other types of assistance. Plan sponsors – who are charged with policing the activity of their agents – often prove less than helpful when beneficiaries complain to them about marketing abuse; plans are often unable to fix enrollment/disenrollment problems, discourage disenrollment from their plan, or simply inform the individual that “nothing can be done.”
Is Medicare Advantage a bad apple?
Although CMS and the insurance industry would like to blame Medicare Advantage marketing problems on a handful of insurance agents engaged in fraudulent activity – a “few bad apples” – the entire Medicare Advantage orchard is subject to rot as long as underlying structural problems continue to remain. Marketing abuses will continue unchecked unless: 1) plans are truly held accountable for the actions of those who sell their products; and 2) beneficiary protections outlined above are put into place. Congress and CMS must act to ensure that Medicare beneficiaries are able to access timely and quality health care as well as make informed decisions – without undue influence – about how they wish to access their benefits through the Medicare program.