Update to the Medicare Marketing Guidelines

[TwoCents]

On June 17, 2014, the Centers for Medicare & Medicaid Services (CMS) released revised Medicare Marketing Guidelines (MMG). We issued an HPMS memorandum on August 14, 2014, clarifying various aspects of the revised MMG, including that MA Plans/Part D Sponsors are prohibited from calling existing enrollees to discuss other plan options (Section 70.6). We have since revisited our decision and concluded that we are reverting to our previous guidance on this matter. Please see the revised language below. This change is effective immediately and the MMG will be updated to reflect this change when we next revise the guidelines.

Plans/Part D Sponsors may do the following:

* Call members to promote other Medicare plan types, (e.g., sponsors may contact their PDP members to promote their MA-PD offerings; sponsors that are also Medigap issuers may market their MA, PDP, or cost plan products to their Medigap customers), and discuss plan benefits.

 

[Sherota1]

Just got an email from one of my carriers with the same update. Thanks for posting it here.

 

[vic120]

Has anyone heard this

I am on a webinar now with a major MA carrier
and they are saying new CMS regulations
restrict agents from mentioning discounts.

The example given was you cant say on mail order you can get 3 month supply for 2 month's

Just seems off that cant be true right?

 

[WCMason]

Has anyone heard this

I am on a webinar now with a major MA carrier
and they are saying new CMS regulations
restrict agents from mentioning discounts.

The example given was you cant say on mail order you can get 3 month supply for 2 month's

Just seems off that cant be true right?

Humana's certification--my last one, which I worked on over the weekend--was the only one that stated that new CMS guidelines prohibited including optional supplemental benefits (like SilverSneakers, discounts) as part of the presentation or prior to enrollment. That's the only thing I've heard other than an earlier thread that mentioned this a week or to ago.

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On June 17, 2014, the Centers for Medicare & Medicaid Services (CMS) released revised Medicare Marketing Guidelines (MMG). We issued an HPMS memorandum on August 14, 2014, clarifying various aspects of the revised MMG, including that MA Plans/Part D Sponsors are prohibited from calling existing enrollees to discuss other plan options (Section 70.6). We have since revisited our decision and concluded that we are reverting to our previous guidance on this matter. Please see the revised language below. This change is effective immediately and the MMG will be updated to reflect this change when we next revise the guidelines.

Plans/Part D Sponsors may do the following:

* Call members to promote other Medicare plan types, (e.g., sponsors may contact their PDP members to promote their MA-PD offerings; sponsors that are also Medigap issuers may market their MA, PDP, or cost plan products to their Medigap customers), and discuss plan benefits.

I saw this, too, and had two thoughts:

1) how does a June 17 memo revise an August 14 memo?

2) The revision states that plan sponsors may call "their" members to promote "their" other offerings. That doesn't seem to make clear that independent agents can contact their clients who have one plan to discuss plans from other companies, but perhaps just other plans from the same carrier. It may mean that, but isn't that clear to me.

 

[vic120]

Humana's certification--my last one, which I worked on over the weekend--was the only one that stated that new CMS guidelines prohibited including optional supplemental benefits (like SilverSneakers, discounts) as part of the presentation or prior to enrollment. That's the only thing I've heard other than an earlier thread that mentioned this a week or to ago.

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I saw this, too, and had two thoughts:

1) how does a June 17 memo revise an August 14 memo?

2) The revision states that plan sponsors may call "their" members to promote "their" other offerings. That doesn't seem to make clear that independent agents can contact their clients who have one plan to discuss plans from other companies, but perhaps just other plans from the same carrier. It may mean that, but isn't that clear to me.

My clarification with Humana is that did not apply to Silver sneakers as that was part of the plan.

That applied to added value benefits like discounts lasted after summery of benefits ended

That if were in the summary of benefits you can speak of it but you know those discount listed in the few pages after the Summery life lock and added dental discounts and what not

----------

This webinar was with Aetna

they were saying CMS is not allowing agents to talk about discounts and that includes discounts by using mail order

In fact they reiterated that we cant speak about the discount In mail order only we can say it is more convenient

Just does not sound right but this guy seemed convinced this is the CMS ruling for 2015

 

[WCMason]

My clarification with Humana is that did not apply to Silver sneakers as that was part of the plan.

That applied to added value benefits like discounts lasted after summery of benefits ended

That if were in the summary of benefits you can speak of it but you know those discount listed in the few pages after the Summery life lock and added dental discounts and what not

----------

This webinar was with Aetna

they were saying CMS is not allowing agents to talk about discounts and that includes discounts by using mail order

In fact they reiterated that we cant speak about the discount In mail order only we can say it is more convenient

Just does not sound right but this guy seemed convinced this is the CMS ruling for 2015

I got exactly the opposite information from Humana. In fact, Silver Sneakers was given as an example of the kind of benefit we cannot discuss prior to enrollment.

I did not attend an Aetna webinar, but did do the local marketing event they required this year at a nearby restaurant, and the online certification. No mention of this...

 

[bpenn9]

I got exactly the opposite information from Humana. In fact, Silver Sneakers was given as an example of the kind of benefit we cannot discuss prior to enrollment.

I did not attend an Aetna webinar, but did do the local marketing event they required this year at a nearby restaurant, and the online certification. No mention of this...

IMO depends on the plan. For instance, in CO anyway, on the Humana PFFS SS is an optional benefit. On the PPO/HMO it IS part of the plan and an actual included benefit. Well, that's how it was for 2014. Maybe they are changing that for 2015?

 

[vic120]

IMO depends on the plan. For instance, in CO anyway, on the Humana PFFS SS is an optional benefit. On the PPO/HMO it IS part of the plan and an actual included benefit. Well, that's how it was for 2014. Maybe they are changing that for 2015?

I am getting the feeling if I talk to 5 reps from Humana
I will get 5 dif answers on Silver sneakers which I got a def ok to talk about fro 1 rep


and I am guessing the same thing if I talk to 5 reps from Aetna get 5 dif answers


How could all these regulation be so unclear that Insurance companies with there budgets and lawyers cant have unity in understanding

Even with themselves, Never mind with each other

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I got exactly the opposite information from Humana. In fact, Silver Sneakers was given as an example of the kind of benefit we cannot discuss prior to enrollment.

I did not attend an Aetna webinar, but did do the local marketing event they required this year at a nearby restaurant, and the online certification. No mention of this...

Yea Crazy because what rep said to me was if it is in summery of benefits it is a benefit not a VAS

if it can be added for prem like dental you can also discuss

but if it is listed after summery of benefits like added dental discount jenny crieg life lock and what not this can not be discussed because these are VAS

 

[insuranceconceptscindy]

I hardly ever talk about what I call the "frou-frou" benefits. Silver Sneakers is nice to have, but it shouldn't sway your decision. I think that's what they are trying to do- making sure clients are using the core benefits of the plan to make their decision, not the discounts and other things.
I actually passed on a prospect to another agent because she was more interested in a plans "frou-frou" benefits than the core stuff- who had the better discount on vitamins and which one carried Silver Sneakers- the fact that her doc was in any plan had no bearing on her decision. I knew I would never make her happy because she wasn't thinking smartly.

 

[TwoCents]

Humana's certification--my last one, which I worked on over the weekend--was the only one that stated that new CMS guidelines prohibited including optional supplemental benefits (like SilverSneakers, discounts) as part of the presentation or prior to enrollment. That's the only thing I've heard other than an earlier thread that mentioned this a week or to ago.

----------


I saw this, too, and had two thoughts:



2) The revision states that plan sponsors may call "their" members to promote "their" other offerings. That doesn't seem to make clear that independent agents can contact their clients who have one plan to discuss plans from other companies, but perhaps just other plans from the same carrier. It may mean that, but isn't that clear to me.

1) how does a June 17 memo revise an August 14 memo? -- You're reading it incorrectly. The new guidelines were issue 6/17 followed by the memo 8/14 followed by this newest guidance.