BREAKING: 2020 CMS Guidelines for Marketing Medicare Plans

As you know, marketing is crucial to your success. It’s not only how you generate fresh leads, but also how you hang on to your existing clients. Every year, CMS releases updated Medicare marketing & communications guidelines to help you stay compliant. The 2020 changes memo is to be used in conjunction with the 2019 Medicare Marketing and Communications Guidelines. CMS will not be providing a full new document this year.

If you have any questions about these changes, reach out to our compliance department at compliance@seniormarketadvisors.com.

New in 2020:

We picked through the 2020 update to the 2019 Medicare Communications and Marketing Guidelines to showcase what may affect independent agents, and this is what we found.

Marketing Outside of Service Areas

Section 40 originally said “Plans/Part D sponsors may only advertise in their defined service area, unless unavoidable…,” but that verbiage has been removed. This means that, for example, if you want to extend your advertising a bit outside of the plan’s county, you technically could do that. There may not be a reason for you to do that, but it may apply in some circumstances. For example, you may have people with power of attorney who do not live in the same plan service area as the person that they have POA for. You can technically market to those people now.

Notice of 5-Star Availability and SEP Eligibility

Subsection 40.6.2 originally said that you “may not inform beneficiaries that they may request a SEP and move to a higher-rated plan if they are dissatisfied with low performing plan.” This means that you can now reach out to your clients who are in low-rated/low-performing plans and inform them that you can help them switch into a five-star plan.

Notice of OEP

Subsection 40.7 prohibited anyone from marketing OEP on their website. There are still regulations about directly targeting those eligible for OEP, but you are now permitted to define and discuss OEP (and other enrollment periods) on your website.

Medicare Educational Event Guidelines

It just became easier for agents to set appointments and make sales related to educational events. Originally, section 50.1 said that you “may set up a future marketing appointment.” The word “future” was removed. Additionally, the language stating that you “may not conduct a marketing/sales event immediately following an educational event in the same general location” has been removed.

Additionally, you no longer have to submit full scripts to CMS before marketing/sales events. That language has been reduced to “talking points,” meaning you no longer have to stay exactly on script to what you submitted (though you’ll still have to stay on task according to your talking points).

Interestingly, according to subsection 60.1, provider-initiated marketing activities are no longer considered marketing and are not subject to marketing regulation.

Websites

CMS added a line to subsection 70.1.1 that you must “include or provide access to (e.g., through a hyperlink) applicable disclaimers as required.” This indicates that you don’t necessarily have to have entire disclaimers in the text on all of your web pages. A link to your disclaimers is all that is required. They also added a note that “the Federal Contracting Disclaimer only has to be placed on one web page,” referring to this disclaimer, ““[Plan’s/Part D sponsor’s legal or marketing name] is a [plan type] with a Medicare contract. Enrollment in [Plan’s/Part D sponsor’s legal or marketing name] depends on contract renewal.””

Then, they also added a line stating that whenever there is a change, that change must be communicated within 30 days.

Additionally, all websites that CMS considers marketing (instead of communication) must be submitted for review and approval via the HPMS (Health Plan Management System) with specific guidelines according to subsection 90.4.1. You will not need to submit test sites or screenshots; a URL with a material ID will be acceptable. See section 90.4.1 for specific instructions for submission and speak with your specific carrier agent oversight department for a submission request.

Summary of Benefits

Part D benefits language now needs to include “cost sharing for deductible, the initial coverage phase coverage gap, and catastrophic coverage.” Additionally, “cost sharing must be broken down by the tier number/name…”

When applicable, plans and sponsors must notate that “costs may differ  based on pharmacy type or status…” and “30 or 90 day supply.”

Important Updates From 2019 that Still Apply: 

These updates were all part of the 2019 Marketing and Communications Guidelines. If you didn’t study the changes last year, now’s your chance!

Unsolicited Email Marketing

Plans may now contact potential members through advertisements, direct mail, and email. All email marketing MUST contain an “unsubscribe” or “opt-out” capability. Additionally, there are specific guidelines that outline what is considered email “communication” vs. “marketing.” Any email that is considered marketing must be submitted for review, whereas communication does not.

Plans and sponsors are still not permitted to use door-to-door or telephonic solicitation and cannot approach enrollees in public areas. However, you can approach enrollees in healthcare common areas, such as hospital cafeterias, recreational rooms, and conference rooms. If your client is an appointment “no-show” and you want to leave some information at the residence, you are still permitted to do so (as long as there was a scheduled appointment). Additionally, you can call your current beneficiaries (before October 1) – you just can’t call fresh leads unsolicited.

Open Enrollment Period

Did you hear about the new open enrollment period from Jan 1 to March 31? Plans are not allowed to send unsolicited materials advertising the ability to make a change during OEP. They also cannot host or promote agent events that advertise OEP as an additional sales period. Most significantly, you cannot call former enrollees who selected a plan during AEP to tell them about OEP. As of 2020, you can mention OEP in a “communication” or “educational” sense, but you still cannot mention it with an intent to market or encourage a beneficiary to switch.

Educational Events

As of 2019, you can now distribute business cards and/or contact information to encourage beneficiaries to initiate contact when you are at an educational event. Business reply cards are also allowed.

Sales Presentations

You are also permitted to conduct sales presentations and distribute CMS-approved marketing materials as long as you do not modify the materials.

Scope of Appointment

A wording update makes it clear that ALL sales, regardless of venue (in-person, over the phone, etc.) must follow the SOA parameters. Reminder: Discussions within the appointment must only relate to previously agreed-upon products and must have been documented in the SOA. Additionally, you may not discuss plans for the following year before October 1.

Click here for official 2019 Medicare Communications and Marketing Guidelines

Click here for the August 2019 update to the 2019 Medicare Communications and Marketing Guidelines