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New Rules Regarding Marketing Medicare Products
:: Overview and Background
:: Additional Medicare Marketing Resources
:: No Meals at Promotional or Sales Events
:: No Cold-Calling
:: No Non-Health Care Product Cross-Selling
:: No Selling were Health Care is Delivered
:: No Sales at Educational Events
:: Use Scope of Appointment Documents
Overview and Background
The Centers for Medicare and Medicaid Services (CMS) have recently released new guidelines for marketing Medicare Part D prescription drug plans (PDPs) and Medicare Advantage plans (MAs and MA-PDs). The new Medicare Marketing Guidelines are developed under the 2008 Medicare Improvements for Patients and Providers Act (MIPPA) (Pub. L. 110-275). Please note that Secret Shopper activity will be greatly increased to ensure adherence to these new Medicare marketing rules. The Marketing guidelines from previous years are still in force and the following rules are newly enacted or defined regulations.
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No Meals at Promotional or Sales Events
Meals may not be served at marketing events. However, CMS will allow “light snacks� including such things as fruits, raw vegetables, pastries, cookies, crackers, muffins, cheese, chips, yogurt, and nuts. Individual Part D plans are called upon to make a determination as to what should be considered a Light Snack or a Meal. If an Agent combines more than three"snacks" together, they may be considered a meal. Beverages are allowed in addition to three snack items. Some Part D plan providers note that no meat-items are on the CMS "Snack List" suggesting that no meat-filled snacks or pastries should be served.
Suggestion:
Some Medicare Part D marketers may simply want to avoid the compliance question of when a snack becomes a meal and only provide beverages at marketing events.
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No Cold-Calling
As was true in previous marketing guidance, CMS marketing regulations prohibit Part D plans and their agents from contacting potential Part D or MA enrollees directly without the potential enrollee first initiating contact. Medicare beneficiaries must initiate the contact. In particular, unsolicited direct contact like door-to-door solicitation, outbound telemarketing calls, approaching Medicare beneficiaries in parking lots, or follow-up calls about mailings without prior consent are some examples of the activities that are prohibited. Cold-Calling also extends to discussing products not agreed to by the client. Beneficiary consent to a sales contact can be evidenced by a CMS-approved Business Response Card (BRC), but contact is limited to the items agreed to on the BRC. An agreement to an initial sales contact is temporary and does not give the marketer the permanent right to contact the beneficiary .
Suggestion:
Keep a written record of how you made initial contact with the Medicare beneficiary (for instance, retain a copy of the BRC or other CMS-approved form. If possible get written permission for future contact with the Medicare beneficiary.
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No Non-Health Care Product Cross-Selling
CMS prohibit Medicare Part D providers and their representatives from cross-selling non-health care related products during Medicare sales or marketing activities. In particular, non-health care products include annuities and life products. A 48-hour cooling off period is required before returning to the Medicare beneficiary with any other Insurance or Financial products.
Suggestion:
Don't stray from the purpose of your sales call. If the Medicare beneficiary has agreed to discuss Medicare Supplements (and this is documented on the Sales Appointment Confirmation Form) and then suddenly wants to discuss Final Expense insurance, make another appointment at least 48 hours later for the non-Medicare product. If you are discussing a Medicare Supplement and the client wishes to learn about Medicare Advantage plans, wait 48 hours before the MA presentation.
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No Selling were Health Care is Delivered
CMS prohibits Part D plans from conducting sales presentations or distributing and accepting plan applications in provider offices or other places where health care services are delivered, except in the case where such activities are conducted in common areas in health care settings.
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No Sales at Educational Events
CMS prohibit Medicare Part D and Medicare Advantage providers (and their representatives) from conducting sales presentations or distributing and accepting plan applications at educational events.
Suggestion:
Secret Shoppers and CMS officials will attend these events. Some Medicare plan providers tell agents not engage participants with anything but a friendly normal greeting - only discuss your Medicare plan when asked. When in doubt, do not sell at an educational event.
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Use Scope of Appointment Documents
The scope of client appointments must be established beforehand - and recorded. CMS established the “scope of client appointments� noting that: “[t]he new [CMS Marketing] rules limit any marketing appointment to the scope of healthcare-related products agreed upon by the beneficiary in advance. For an in-person appointment, the scope agreed upon must be documented in writing. If the appointment is made over the phone, the conversation must be recorded.� (Source: CMS Fact Sheet)
Suggestion:
Be sure to always use the Scope of Appointment Document (download below) and keep a signed copy for your records - along with the original Medicare beneficiary contact document.
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:: CMS Sales Appointment Confirmation Form
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