Navigating the Latest CMS Regulations

Compliance is critical for ensuring transparency and protecting participants but also for avoiding potentially costly penalties. 

Doctor in a white coat holding a clipboard with a stethoscope and writing something

Recently, the Centers for Medicare and Medicaid Services (CMS) released an update to its rules that has significant implications for insurance agents and Medicare agencies that market Medicare plans. These changes aim to enhance transparency, protect participants and ensure that any information provided is accurate. They take effect Sept. 30, 2023.

Let’s look at some of the changes: 

Direct Submission of Marketing Material by TPMOs 

One of the most significant changes is the requirement for third-party marketing organizations (TPMOs) to submit their marketing materials directly to CMS for approval. In previous guidelines, TPMOs were responsible for submitting material to the respective Medicare Advantage (MA) organizations or Part D sponsors. The new rule mandates that TPMOs obtain prior approval from each organization or sponsor and submit the material directly to CMS for review. This ensures that marketing collateral meets CMS guidelines and receives the necessary approvals before participants see it. 

This change means TPMOs must streamline their internal processes to accommodate the direct submission to CMS and ensure compliance with the approval requirements of individual organizations and sponsors. Partners, such as Total Expert, can help TPMOs streamline marketing collateral development and approval workflows while remaining compliant at every step with automated workflows and pre-built content templates.

Disclaimer Changes for TPMOs

TPMOs must also include standardized disclaimers in their marketing material. These disclaimers will inform participants about the TPMO’s representation of MA organizations or Part D sponsors and the range of plans available. The disclaimers differ based on whether TPMOs represent all MA organizations or Part D sponsors in a service area or only a select number. Insurance agents and Medicare agencies must incorporate the required disclaimers accurately in their marketing collateral and provide participants with clear information about available plan options. 

See also: Navigating Confusing Insurance Regulations

Guidance on Misleading Use of Medicare or CMS Name and Logo 

To protect participants from misleading information, the new CMS rule strictly prohibits the use of the Medicare name, CMS logo and products or information issued by the federal government in a misleading way. However, a slight modification to the rule now permits the use of the Medicare card image with authorization from CMS. This change aims to strike a balance between accurate representation and preventing deceptive practices.

For insurance agents and Medicare agencies involved in marketing Medicare plans, this rule demands that you adhere to the guidelines and obtain proper authorization from CMS when incorporating Medicare-related branding elements like the Medicare card image in marketing collateral. Ensuring accurate and transparent representation builds trust of participants and avoids potential compliance issues that could lead to significant fines for each violation. 

Clear Identification of MA Organizations and Part D Sponsors 

To provide participants with clear and accurate information about the entities behind the marketing material, the new CMS rules require marketing materials to clearly identify the MA organization or Part D sponsor offering the products or plans. If the MA organization or Part D sponsors involved are clearly identified, participants can make informed decisions about their Medicare plan choices. 

For insurance agents and Medicare agencies, transparency is not optional. Participants must have clear and easy access to further information about the plans and services being advertised.

Restrictions on Unsubstantiated Superlatives 

The new CMS rule introduces limitations on the use of superlatives such as “lowest premium” or “largest network” in marketing collateral. Such superlatives must be supported by documentation, which should reflect the current or prior year and be easily accessible to participants. 

For insurance agents and Medicare agencies, many of today’s common marketing communication approaches will no longer be allowed. Any claims about service quality, price, etc. must be backed by reliable data and documentation. Incorporating such supporting information not only complies with CMS guidelines but also earns trust with participants who seek reliable information to make informed decisions about their Medicare plans.

Penalties for Violating CMS Rules

CMS exists to protect Medicare and Medicaid participants, a group that has often been targeted by misleading and predatory marketing practices. As a result, CMS will not hesitate to levy fines of up to $5,000 for each violation of their policies.

See also: Balancing Innovation, Compassion in Life Insurance

Compliance with the new CMS rules is critical for ensuring transparency and protecting participants but also for avoiding potentially costly financial penalties. 

Outdated technology and internal processes will make it difficult to comply with the new CMS rules. By embracing a modern technology platform like Total Expert, agents can feel empowered to deliver compliant communications and marketing collateral.

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