Is The CMS Marketing For Medicare Advantage Plans?

By: Thomas Wright
Published: Wednesday, December 19 2018
Last Updated: 2 months ago

The subject lines of your emails will start looking a bit differently according to a report in The New York Times. Since the enrollment period for Medicare Advantage plans ended in early December, federal officials predicted that 37% of the 60 million beneficiaries will be enrolled in Medicare Advantage plans by 2019. This is a 28% increase from previous years.

Emails had subject lines asking beneficiaries to receive more benefits for their money. Other emails told them they could save more on their Medicare Advantage plans. These emails are being paid for by the US Department of Health and Human Services and are urging beneficiaries to check out other Medicare Advantage plans. To learn more about their different options, they're urged to use an online Medicare plan locator tool.

This all changed on July 20, when the Centers for Medicare and Medicaid Services introduced their new Medicare Communications and Marketing Guidelines. These guidelines are for beneficiaries under the Medicare Advantage plan and Part D plans. This builds upon last year's CMS marketing guidelines, which loosens restrictions on plans.

This is reflective on the Trump administration's approach to reducing the amount of policing on the Medicare marketing plan, compared to the Obama administration. Here are some ways that marketing plans for Medicare are expected to change.

Fewer Materials To Review

One of the biggest changes to consider is that there will be fewer marketing materials for the CMS to reviews. This change is reflected under the new MCMG as it replaces the previous guidelines. Under the new MCMG, not all communications sent to a beneficiary or member are considered marketing communications.

In order to remove the materials that are considered marketing materials, the plan must encourage the individual to enroll in its products and services. The marketing material must contain details about the plan that's being offered. The MCMG states that a flyer that asks an individual to call for more information doesn't qualify as marketing material.

The flyer can be used to attract the individual's attention to a particular plan, just as long as it doesn't include any information about the benefit structure, cost-sharing, or ranking of the particular plan. It's simply being used as communication material, not marketing material.

Marketing is defined as a set of communications that attract a beneficiary's attention to a particular plan for enrollment or to stay enrolled in a private plan. It should also contain information about the benefit structure, cost-sharing, and ranking standards.

Expands Provider Communications

The narrow scope of the word marketing has an implication when providers communicate with their patients about private plans and Part D plans. CMS prohibits providers from using marketing materials in clinical and healthcare settings, although materials can be made available in lobbies and waiting rooms. This rule doesn't just apply to communication materials. For example, a physician could display flyers or brochures in an exam room without violating this rule.

The new MCMG also removes the prohibition on removing providers from appearing in endorsements or testimonials. Plans can now include quotes from providers in marketing materials. Also, the Centers for Medicare and Medicaid Services allows providers to discuss the various Medicare plans with their patients. They can talk about the advantages of each of the plans, just as long as they're not doing it on behalf of a particular plan.

Other Notable Changes

The MCMG has also loosened restrictions on Medicare marketing materials in other areas. In the past, plans could be compared to other plans through the use of studies or other factual data. Now, plan comparisons are allowed as long as they're factually based. Agents can provide business cards to potential members at educational events, an activity that previously wasn't allowed.

The Centers for Medicare and Medicaid Services previously revealed that call centers shouldn't ask beneficiaries if they wanted to be transferred to a sales department. They also couldn't transfer that member automatically. That rule is now omitted.

It has also included more language to the MCMG to allows plans and agents to email potential members and market private Medicare plans to those individuals without violating the rules on unsolicited e-mail communications. The government is no longer involved when it comes to the way that agents and private Medicare plan market to beneficiaries.

The CMS has certainly changed the way that marketing activities can be conducted under private Medicare plans and Part D plans. These new marketing activities are still heavily regulated, and both agents and plans must comply with these new rules to exercise compliance.

Medicare Advantage plans have a wide variety of benefits, ranging from dental care and gym memberships to meals on wheels and prescription drug coverage. Private Medicare plans protect against rising health care costs, with a cap on out-of-pocket spending for doctor's visits and hospital services. In addition, these plans provide an all-in-one experience for their coverage.

Beneficiaries typically pay one premium for doctor's services, another premium for prescription drug coverage, and an additional premium for supplemental insurance. While most of these plans promote high-quality care, it's unclear whether these plans have an advantage over traditional senior health care plans.