The Centers for Medicare and Medicaid Services (CMS) ensure that Medicare beneficiaries are receiving access to great care and improving health. CMS frequently reviews current and future regulations for various Medicare Advantage plans. It is important to stay up to date with CMS regulations and understand how they affect you and your beneficiaries. On April 5th, 2023 the final ruling was made regarding the 2024 Medicare Advantage and Medicare Prescription Drug Plans focusing on Medicare communications and marketing compliance. The ruling will go into effect next AEP or plan year.
Main takeaways from the new rule that will affect your business:
48-hour Scope of Appointment Time Restriction
CMS has re-implemented the 48-hour rule between Scope of Appointment (SOA) and agents meeting with beneficiaries. There are exceptions for walk-ins and during the end of both the Annual Enrollment Period (AEP) and Open Enrollment Period (OEP). According to CMS, SOAs are only valid for six months after a beneficiary has signed.
CMS wants to ensure that beneficiaries have clear and effective communications with agents regarding coverage. We’ve listed several key changes indicated by the ruling, but please note that there are several other marketing requirements that aren’t included in the list below.
Key changes indicated by this rule:
- No marketing events at the same location within 12 hours of an educational event.
- Limited use of the Medicare name, logo, and Medicare card.
- Marketing plan benefits in an area where benefits are not available are prohibited.
- Marketing information that revolves around savings (specifically when in regards to the comparison of typical expenses for uninsured individuals, unpaid costs of dually eligible beneficiaries, or other unrealized costs of a Medicare beneficiary).
- Collection of SOA cards at educational events is prohibited.
- Words like “most” or “best” when referring to Medicare assistance are prohibited in marketing materials (unless providing data from the previous year to support the statement).
The final ruling of Medicare Advantage and Prescription Drug Plans will go into effect June 5th, 2023 and are applicable to coverage beginning January 1, 2024. To read the full CMS ruling use the following links 2024 CMS Final Ruling.
How Spark Can Help
We know new regulations can be challenging to understand and navigate. Spark is here to ensure you have up-to-date Medicare information and help you run your business compliantly while you grow and help Medicare beneficiaries get the best care possible.
Have questions or concerns? Reach out to firstname.lastname@example.org. We look forward to hearing from you!