Educational events should be used solely for education and not for lead generation or future marketing opportunities for agents. Marketing events are prohibited from taking place within 12 (twelve) hours of an educational event in the same location. The same location is defined as the entire building or adjacent buildings.

This rule would have impacted third-party lead generation during the upcoming AEP. However, it WAS NOT FINALIZED. CMS indicated they may revisit this proposed rule in future plan years. It’s important to have a diverse source of leads and to encourage self-generation where possible.

The CMS ruling specifically states no one can use the words medicare or Medicaid or a government image in a misleading fashion.

Agencies that conduct business in the state of Florida would have received a letter from the Department of Insurance requiring them to remove the word “Medicare” from their agency name no later than June 30, 2023. If they do not make this change, their licenses will not be renewed on July 1, 2023. Note: They also cannot add a DBA (doing business as) in Florida if they are domiciled in another state; they must change the name of their agency across the board.

The guidance is that the disclaimer must state the number of available products and plans the agent supports in the beneficiary’s area. We’ll release more detailed scripting at a later date.

YourMedicare’s Compliance team will help submit marketing materials to CMS on your behalf as long as you are contracted to sell that carrier’s product with YourMedicare.

Yes, the agent would need to restate the disclaimer.

Given several new regulations regarding Marketing Material for AEP ’24, it’s our recommendation that agents/agencies heavily rely on communication versus marketing materials.

1. Marketing materials must be reviewed by carriers prior to CMS.
2. Marketing must clarify the number of organizations, products and plans specific to the beneficiary’s area.
3. Marketing materials must clearly display the name of the sponsor.

Marketing is anything that is intended to draw a beneficiary to a specific MA plan and can include any of the following: plan premiums, cost sharing and benefit information. Communication is general in nature.

This must be done not state-by-state, but rather county-by-county, and should include PDP plans in the count.

There is no firm date for the release of the FCC’s forthcoming rulings, but we anticipate an announcement by midsummer.

Mailer cards must be tailored to individual markets and include dislaimer information (in minimum 12-point font) that specify market-specific carrier information and plan availability.

PTC or a BRC that are collected prior to Sept. 30, 2023, are valid for six months from the date they were received. After Step. 30, 2023, they will be valid for 12 months.

Yes, you can mention general benefits such as dental, vision and hearing. However, upon doing so, these materials are no longer considered communications but marketing and must be submitted to carriers and CMS for approval.

The image of the Medicare card may not be used for marketing purposes in any way, however the image may be used for educational purposes, as long as you’ve received prior authorization from CMS.

Yes, carriers must still pre-review and approve all scripts before agents may submit them to CMS for “file and use” (which may occur on the sixth day after filing).

The 48-hour rule applies unless there is a qualifying election code during the last four days of the month. Ruling states “we will not apply the 48-hour rule if the SOA is completed during the last four days of the election period.”

This is currently an open question that our team is actively working on to ensure we have an aligned interpretation across all of our carriers, as well as CMS.  Once the interpretation is final, we will release more details.

If you leverage Marketing Material, each product/carrier associated with the material must sign off prior to submission to CMS.

Yes, the requirement applies to all enrollments, including telephonic enrollments.

Yes, the 48-hour rule applies to all enrollments, including call centers. CMS has clarified that it does not apply to walk-ins and inbound consumer phone calls or those enrolling in the last four days of a valid election period.  If any of the exceptions apply,  then the agent would be able to collect a SOA and then continue with the enrollment, if the consumer wishes to do so.

There is no firm date for the release of the FCC’s forthcoming rulings, but we anticipate an announcement by midsummer.

Yes. If the client asks about a Medicare Advantage plan, the agent can take a Scope of Appointment but cannot discuss MA during the same appointment.

Currently, a Scope of Appointment is good for six months from the date it was set. However, beginning July 10, 2023, a Scope of Appointment will be good for 12 months from the date it was set.

Our current interpretation is that, yes, a customer service representative can collect a Scope of Appointment for a licensed agent.

No. A Scope of Appointment is specific to an agent and cannot be moved from person to person. In other words, when a Scope of Appointment is collected, the consumer must know who will be contacting them in 48 hours to discuss plan enrollment. This information cannot be left as an open item.

CMS will provide a PECL. There is no expected available date on this currently. 

No. However, they can elect to waive this requirement if (a) they are a walk-in or (b) their request takes place during the final four days of an election period.

No, agents may not provide quotes or comparisons anytime during the 48 hours prior to their appointments. This is a specific requirement of the SOA. Any such engagement prior to the set appointment would be construed as a “meeting.”

Some agents do collect this information from existing clients from year to year, usually via a form that has been mailed to the client and sent back to the agent via mail. Unfortunately, given the recent changes to the SOA, we would advise sending the form to the client to complete prior to your meeting but collect the information at the set appointment. This will allow the client to gather the necessary information together to ensure a more streamlined process and productive appointment.

No. If an appointment is set, the information should be collected at that time. In a call center setting, a customer service representative could take basic information before the agent reviews the sales and enrollment information.

Yes, an SOA is needed for all enrollments and must be retained or submitted with the enrollment application.

No, SOA’s cannot be distributed or collected at marketing events.

If you have express written consent to text the beneficiary, then yes, an SOA sent via text message – so long as it contains all required information on an electronic or paper SOA – is considered TCPA compliant. As a reminder, the agent would need to retain the SOA via text message for 10 years and be able to produce it if requested by a carrier of CMS.

Yes, a call center must wait 48 hours after receiving an SOA before discussion and enrollment into a Medicare Advantage (MA) plan.

Yes, if a beneficiary calls in (i.e., not a warm transfer) and asks to discuss or enroll in a plan, then the 48-hour waiting period does not apply per CMS. As a reminder, the agent would need to retain the call recording for 10 years and be able to produce it if requested by a carrier of CMS.

Yes, if a beneficiary calls in (i.e., not a warm transfer) and asks to discuss or enroll in a plan, then the 48-hour waiting period does not apply per CMS. As a reminder, the agent would need to retain the call recording for 10 years and be able to produce it if requested by a carrier of CMS.