By Maggie Stedt

It is never too early to start your preparation for Medicare Plan Annual Open Enrollment. The AHIP and NAHU certifications have opened up earlier this year and almost all the carriers are providing trainings on-line with some offering in-person meetings. Take advantage of the opportunities to attend the Medicare Summits and other meeting opportunities by carriers, FMOs and your local California Agent Health Insurance Professionals (CHIP) to learn about new products, product changes and marketing requirements.

Marketing Changes for 2023

This year will require much more planning due to the Centers of Medicare & Medicaid Services (CMS) Marketing Guidelines released in May of this year. The changes made by CMS were in response to the many complaints by agents and beneficiaries regarding the noncompliant marketing of telemarketing entities and call centers. Unfortunately, we independent agents were included in the broad brush of this CMS reaction.
According to July 1 NAHU (National Association of Health Underwriters) News release: “A CMS rule revising Medicare Advantage and Part D marketing and communication regulations went into effect June 28 to increase oversight over third-party marketing organizations. Medicare Advantage and Medicare Part D plan sponsors must comply with the new CMS rule first put forth on May 9.

Six things to know:

  • TPMOs (Third Party Marketing Organizations) are now defined as “organizations and individuals, including independent agents and brokers, that are compensated to perform lead generation, marketing, sales and any enrollment-related functions as part of the chain of enrollment.”
  • TPMOs must display a disclaimer that says, “We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact or 1-800-MEDICARE to get information on all of your options.” This must also be given verbally, electronically or in writing, unless the TPMO explains every plan available
  • Plan sponsors will be responsible for making sure all TPMOs follow the requirements.
  • Plan sponsors and their subcontractors must require TPMOs to disclose any applicable subcontracted relationships.
  • Plan sponsors must ensure that TPMOs notify members of the TPMOs’ role.
  • Plan sponsors must have oversight over any company performing marketing services on their behalf and must document that oversight, along with any actions taken against TPMOs not compliant. Failure to do so could result in financial or operational penalties.

Note that agents are included in the ruling and are required to record their marketing phone calls with prospects and clients. These means that we will need to seek out a system that meets the requirements for recording and data storage. Our Field Marketing Organizations (FMOs) other entities are in the process of securing these systems and will be offering them to their agents. Independent agents should explore the various offerings that are becoming available for example, by CRM’s and others.

The additional requirement is the display of the disclaimer shown above in bullet number two. Agents can work with their carriers and FMOs for any marketing materials including websites and other marketing for approval to include this disclaimer.

AEP Marketing and Sales Opportunities

Just a reminder of the opportunity and preparation for Annual Open Enrollment:

  • Make sure to follow the Medicare Marketing guidelines for meetings and materials and to always file your sales meetings with the respective companies for the products you will be representing. Meetings may be scheduled for in-person or using a virtual platform such as ZOOM.
  • Client Retention should a priority by reaching out to your clients during this important enrollment period to help them determine if they wish to remain on their current plan or considering changing.
  • Develop relationships with physicians, pharmacies, senior service centers and local chamber of commerce to provide ongoing service and information regarding AEP and Aging into Medicare information.
  • Carefully review the Annual Notice of Change (ANOC) for the various plans you represent to see if Guaranteed issue situation applies to change to a Medicare Supplement Plan.
    (Review the Medicare Supplement company’s GI outline to specifically see which Medicare Supplement plans may be offered, what is required to qualify and what must be submitted for proof of prior coverage.

With preparation, planning, study and commitment you will have a successful and compliant AEP and can be confident that you have done the best you can for your clients, your business and your family. Go get ‘em!

MAGGIE STEDT, CSA, LPRT, Senior Summit co-chair, Medicare chair of Orange County Association of Health Underwriters and immediate past president of CAHIP.