Blog

For the Medicare marketing world in 2022, the Centers for Medicare & Medicaid Services (CMS) has proposed big changes. Here’s an overview of what’s been happening with consumer marketing regulations …

Strengthening oversight of 3rd party marketing organizations.

The Joe Namaths and Jimmy “J.J.” Walkers of the Medicare world were already put on notice back in October 2021 when CMS issued a memo about Third-Party Marketing Organizations (TPMOs).

Now, after significant increases in marketing-related complaints, CMS is formalizing that alert into new TPMO regulations for Medicare Advantage and Part D plans for the contract year 2023.

Proposed new CMS rules increase oversight of TPMOs to prevent “deceptive marketing tactics.”

These new rules are designed to ensure Medicare beneficiaries get accurate and accessible information. Here’s an overview of what’s to come:

1. CMS will define TPMOs as organizations that do lead generation, marketing, sales, and enrollment — which brings with it tighter regulations.

2. CMS will require that TPMOs working with MA and Part D plan insurers, directly or indirectly, include a standard TPMO legal disclaimer to be prominently displayed on all consumer-facing materials.

3. Any MA or Part D plan doing business with a TPMO will have to ensure their TPMO adheres to the same regulations CMS requires of their own plan’s marketing efforts.

4. TPMOs that run lead-generation marketing efforts must inform any Medicare beneficiary that their personal information will be shared with a licensed insurance agent for contact in the future, or that their phone call is being transferred to a licensed agent to help with enrollment.

New TPMO regulations for Medicare Advantage and Part D plans mean more due dilegence will be required for Medicare marketers.

In addition, CMS is planning to reinstate multi-language translation insert requirements for specified marketing materials, as well as update some legal disclaimer requirements.

Provider affiliation activities get stricter guidelines.

From now on, Medicare plans will have to walk a fine line when including provider affiliations in their marketing/communications mix. That’s because CMS has recently updated their guidelines to further specify what messaging is and is not allowed for activities with health care providers or in the health care setting. Here are what the new guidelines state when it comes to plans announcing new or continuing affiliations:

• Provider affiliation announcements made by plans that do not include marketing content are considered communications. If the announcement contains marketing, the announcement must be submitted into HPMS.

• Provider affiliation announcements made by providers may not include marketing content. For example, an announcement that says Dr. Smith is now accepting Medicare Advantage X, and then provides cost sharing or other marketing content/intent (e.g., Plan X is the greatest Medicare Advantage Plan) would be prohibited.

Affiliation announcements will still be an important part of your marketing mix. Only now, anything that could be construed as “marketing content” will have to be stealthily crafted.

New restrictions limiting gift card incentives.

In direct response, the “offer” is critically important to help generate leads and conversions. But that too is being even more closely scrutinized … CMS has agreed with the Office of Inspector General (OIG) regarding the use and restrictions on gift incentive cards. CMS has said that gift card offers will now be:

1. Restricted to a limited “specific” selection of items or food, or restricted to a specific retail chain. For instance, Medicare marketers can offer gift cards from Starbucks (coffeehouse) or a Shell (gas station).

2. $15 maximum amount per offer, with a total of $75 aggregate per person, per year for a member.

Please also note that the OIG uses “cash equivalents” (items convertible to cash, such as a check; or items that can be used like cash, such as a general-purpose debit card) to determine eligibility.

What’s that all add up to for Medicare marketers? Some commonly used gift cards will now be prohibited:

1. General gift cards — those that are not restricted to specific retail chains or to specific items. For instance, a simple $10 Visa^® gift card is no longer allowed.

2. Gift cards for retailers or online vendors that sell a wide variety of products. For instance, gift cards/vouchers from Amazon and Walmart are no longer allowed.

In direct response marketing, the “offer” is critically important to help generate leads and conversions.

Medicare plans need to review their marketing campaigns now!

To ensure compliance with these new changes to CMS marketing guidelines, we recommend that you examine any creative currently in-market or in development. And don’t wait, because redoing tactics and/or reconfiguring offers and fulfillment can take a lot more time than expected — and Medicare’s AEP will be here before you know it!

If you need expert help to get it done, DMW is an award-winning, direct response agency that’s been marketing Medicare insurance for 38+ years — we know CMS like the back of our hand. So reach out for a no-obligation consultation today. We’ll help you stay compliant, and stand out in your marketplace.