CMS Medicare disclaimer changes for 2024, plus 18 other things agents need to know

On Wednesday, April 5, the Centers for Medicare and Medicaid Services (CMS) released a final rule governing policy and technical changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-inclusive Care for the Elderly.

For health insurance agents and brokers, what matters most is the changes and additions to rules that cover marketing behaviors. We’ve organized those changes into a brief digest below.
All changes are effective on September 30, 2023 for all activity related to plan year 2024.

The disclaimer is changing
CMS will now require all third party marketing organizations (TMPOs) to mention both State Health Insurance Assistance Programs and the number of organizations and plans represented. The new standardized disclaimer will now read:

“We do not offer every plan available in your area. Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.”

Or, if you do represent all plans in an area, a new disclaimer has been added:

“Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. You can always contact Medicare.gov, 1-800- MEDICARE, or your local State Health Insurance Assistance Program (SHIP) for help with plan choices.”

This means you’ll need to update your website, email signature, and other marketing materials. Also, be sure to keep reading the disclaimer within the first minute of your calls. 

Changes to the call recording requirement
The final rule makes changes to the call recording requirement that was put in place last year.

Here’s what you need to know:
1.    The rule clarifies that the requirement does apply to video calls, like Zoom or other videoconferencing tools.
2.    The requirement is now narrowed to marketing (sales) calls and enrollment calls. There’s no need to record any service-related calls you might make or receive.

Changes to appointment flow
3.    Scopes of Appointment may not be collected at educational events.
4.    The 48-hour rule is reinstated – there must be a 48-hour cooldown between when the Scope is collected and meeting with the beneficiary. Exceptions exist for beneficiary-initiated walk-ins and the end of a valid enrollment period (e.g. – the last day of AEP). 
5.    Agents may call beneficiaries no later than 12 months after the first request for information.
6.    Whenever an enrollment decision is made, agents must explain the effects of an enrollment choice on current coverage.

Changes to agent marketing behaviors, events and materials
7.    The rule clarifies that door-to-door contact is still prohibited even after the agent has received a business reply card or Scope of Appointment.
8.    Agents must list all Medicare Advantage and/or Part D organizations they represent on any marketing materials.
9.    Marketing events may not occur within 12 hours of an educational event at the same location.
10.    Tighter, discrete limits are now placed on using the Medicare name, logo and card in marketing materials.
11.    Superlatives (words like “best,” or “most,”) are prohibited in marketing materials, unless current-year material is available to support the statement. 
12.    Agents must submit any self-made marketing materials to CMS’s Health Plan Management System, but only after the materials have been approved by any Medicare Advantage or Part D plans represented.

Changes required of health plans
13.    Summaries of Benefits are now required to list medical benefits in a specific order
14.    Plans must notify beneficiaries annually, in writing, that they may opt out of phone calls regarding Medicare Advantage and Part D business
15.    Medicare Advantage and Part D plans are required to have an oversight program that monitors agent/broker activity and reports non-compliance to CMS 

Changes required of all organizations
16.    Organizations may not market benefits in a service area where those benefits are not available, unless that is unavoidable because of local or regional or media use.
17.    Organizations are prohibited from marketing information about savings available that are based on a comparison of typical expenses borne by uninsured individuals, unpaid costs of dual-eligible beneficiaries, or other unrealized costs.
What’s not addressed
18.    CMS did not address its proposal to prohibit TPMOs from sharing beneficiary contact information, but reserves the right to address the topic at a later date.

Even though so much is changing, our individual team is ready to answer any questions you might have. They can also walk you through using our free call recording solution. Not yet working with Action? Contact David Blackburn or Robert Hamelin.