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CMS’ 2024 MA and Part D Final Rule Changes: A Comprehensive Overview for Agents

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Comprehensive Regulatory Guidelines for Medicare Marketing in Contract Year 2024

Marketing is only allowed if the names of the MA organizations or Part D sponsors being advertised are clearly displayed.

New Marketing Rules for Contract Year 2024:

1. Clear Disclosure of MA Organizations and Part D Sponsors:
It is now mandatory for MA organizations and Part D sponsors to clearly display their names or marketing names in any promotional material. This ensures that beneficiaries are fully informed about the organization they are dealing with. (Page 386)

2. Prohibition on Unrealistic “Savings” Marketing:
MA organizations and Part D sponsors are prohibited from claiming potential savings by comparing costs to uninsured individuals or those with outstanding medical bills. They cannot use costs that Medicare beneficiaries haven’t actually incurred. (Page 388)

3. Clarification on Door-to-Door Solicitation:
Visiting a Medicare beneficiary at their home is considered unsolicited door-to-door contact, except when the beneficiary has agreed to a prearranged appointment. (Page 391)

4. Annual Opt-Out Reminder for Plan Business:
Each MA organization and Part D sponsor must provide opt-out information to all enrollees, regardless of their plan intention to contact, at least once a year in writing. This ensures that beneficiaries are aware they can opt out of being contacted by their MA organization/Part D sponsor regarding plan business at any time. (Page 392)

5. Prohibition on SOA Distribution and Future Sales Meetings at Education Events:
The new rule reinstates the prohibition on accepting Scope of Appointment (SOA) cards or collecting beneficiary contact information at educational events. (Page 394)

6. Separation of Sales Events from Educational Events:
Marketing events are not allowed to take place within 12 hours of an educational event at the same location. This ensures beneficiaries have sufficient time to consider the impartial and factual information provided during educational events. (Page 399)

7. 48-Hour Rule for SOA and Beneficiary Meetings:
The 48-hour rule for the Scope of Appointment (SOA) is reinstated, with exceptions for beneficiaries nearing the end of a valid enrollment period or for walk-in meetings initiated by the beneficiary without prior scheduling. (Page 406)

8. 12-Month Time Limit for SOAs and BRCs:
The Scope of Appointment (SOA) and business reply cards (BRCs) now have a clear time limit of 12 months from the beneficiary’s signature date or request for additional information. If the original SOA or permission to contact (PTC) has expired, a new one is required. (Page 410)

9. Impact on Current Coverage Communication:
As part of the enrollment process, agents must clearly communicate the impact of a client’s enrollment decision on their existing coverage. (Page 414)

10. Updated TPMO Disclaimer:
When promoting Medicare Advantage or Part D insurance plans, the updated TPMO disclaimer must be included in all marketing materials, such as websites, brochures, or phone calls. The disclaimer should be specific to the service area and included within the first minute of any audio presentation or call. (Page 419)

11. Monitoring and Oversight Plan for MA Organizations and Part D Sponsors:
MA organizations and Part D sponsors are required to have a monitoring and oversight plan, including checking internal and 1-800-MEDICARE complaints, reviewing sales and enrollment call recordings, and evaluating in-person and web-based events incognito. Non-compliance by agents must be reported to CMS. (Page 425)

12. Limited Call Recordings for TPMOs:
Call recordings are now limited to those related to sales, marketing, and enrollment activities, as opposed to recording all calls. (Page 431)

13. Requirement for Recording Web-Based Technology Meetings:
Web-based technology meetings, including platforms like Zoom, Facetime, or Skype, must be recorded. This requirement applies only to the audio portion of the call. (Page 434)

14. Prohibition on Misleading Use of Medicare Name, Logo, or Watermark:
The use of the Medicare name, CMS logo, products, or information issued by the Federal Government, including the Medicare card, is strictly prohibited in a misleading manner. Authorization may be granted for specific uses of the Medicare card image. (Page 372)

Please note that the above list does not include every change in the final rule for Contract Year 2024. As an independent agent, it is crucial to thoroughly read and comprehend the complete details to ensure compliance with your sales processes.

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