Knowledge Base Article

Understanding the many parts of Medicare (i.e., Part A, Part B, Part C and Part D), can be confusing. As a case manager, too often, one of my patients with Medicare Part C coverage was surprised and dismayed to learn they would have a co-payment on day one if transferred from the hospital to a Skilled Nursing Facility (SNF). In other instances, a patient’s insurance would contact us to let us know our hospital was out of network and needed to be transferred to an in-network facility for their specific Medicare Advantage Plan.

On April 5, 2023, CMS issued the 2024 Medicare Advantage and Part D Final Rule (CMS-4201-F). This article focuses on protecting beneficiaries and new marketing requirements for Medicare Advantage (MA) plans. A related CMS Fact Sheet reviews this and other major provisions of the final rule.

Per CMS, the final rule “takes critical steps to protect people with Medicare from confusing and potentially misleading marketing while also ensuring they have accurate and necessary information to make coverage choices that meet their needs.” CMS is “finalizing requirements to further protect Medicare beneficiaries by ensuring they receive accurate information about Medicare coverage and are aware of how to access accurate information from other available resources.”

The following excerpt from the final rule details finalized changes to combat misleading marketing practices:  

• Notifying enrollees annually, in writing, of the ability to opt out of phone calls regarding MA and Part D plan business.
• Requiring agents to explain the effect of an enrollee’s enrollment choice on their current coverage whenever the enrollee makes an enrollment decision.
• Simplifying plan comparisons by requiring medical benefits be in a specific order and listed at the top of a plan’s Summary of Benefits.
• Limiting the time that a sales agent can call a potential enrollee to no more than 12 months following the date that the enrollee first asked for information.
• Limiting the requirement to record calls between third-party marketing organizations (TPMOs) and beneficiaries to marketing (sales) and enrollment calls.
• Prohibiting a marketing event from occurring within 12 hours of an educational event at the same location.
• Clarifying that the prohibition on door-to-door contact without a prior appointment still applies after collection of a business reply card (BRC) or scope of appointment (SOA).
• Prohibiting marketing of benefits in a service area where those benefits are not available, unless unavoidable because of use of local or regional media that covers the service area(s).
• Prohibiting the marketing of information about savings available that are based on a comparison of typical expenses borne by uninsured individuals, unpaid costs of dually eligible beneficiaries, or other unrealized costs of a Medicare beneficiary.
• Requiring TPMOs to list or mention all of the MA organization or Part D sponsors that they represent on marketing materials.
• Requiring MA organizations and Part D sponsors to have an oversight plan that monitors agent/broker activities and reports agent/broker non-compliance to CMS.
• Modifying the TPMO disclaimer to add SHIPs as an option for beneficiaries to obtain additional help.
• Modifying the TPMO disclaimer to state the number of organizations represented by the TPMO as well as the number of plans.
• Prohibiting the collection of Scope of Appointment cards at educational events.
• Placing discrete limits around the use of the Medicare name, logo, and Medicare card.
• Prohibiting the use of superlatives (for example, words like “best” or “most”) in marketing unless the material provides documentation to support the statement, and the documentation is based on data from the current or prior year.
• Clarifying the requirement to record calls between TPMOs and beneficiaries, such that it is clear that the requirement includes virtual connections such as video conferencing and other virtual telepresence methods.
• Requiring 48 hours between a Scope of Appointment and an agent meeting with a beneficiary, with exceptions for beneficiary-initiated walk-ins and the end of a valid enrollment period.

CMS notes they did not address their “proposal to prohibit TPMOs from distributing beneficiary contact information in this final rule and may address it in a future final rule. These changes will become effective on September 30, 2023 for all activity related to CY 2024.