Medicare Marketing Guidelines

Contract Year 2021 and 2022 Medicare Advantage and Part D Proposed Rule

Rules Renamed to "Medicare Communications &
Marketing Guidelines"

The Medicare Marketing Guidelines (MMG) have seen some significant changes since 2019. The MMG, which governs Medicare Advantage Organizations (MAO) and Plan D sponsors, were also re-named to Medicare Communications and Marketing Guidelines (MCMG).

In this article, we’ll take a look at some important changes to the regulations that you should be aware of moving forward.

Below, I have highlighted some of what we consider the most relevant changes to the guidelines. It is not an exhaustive list, but I think it’s a good place to start.

The following sections have changed since 2019:

20 – Communications and Marketing Definitions
30.6 – Electronic communication Policy
40.2 – Marketing Through Unsolicited Contacts
50.3 – Personal/Individual Marketing Appointments
60.4 – Plan/Part D Sponsor Activities in the Healthcare Setting
90.1 – Material Identification

[ Note: Plans/Part D sponsors may impose additional restrictions on their subcontractors, downstream entities, and/or delegated entities, provided they do not conflict with the requirements outlined in the MCMG. ]

Let's look into some of the changes to the Medicare Communications and Marketing Guidelines:

20 – Communications and Marketing Definitions:

The most obvious change to this section is the distinction between Communications activities and Marketing activities. Communications activities do not need to be submitted for CMS review.

The MCMG defines Communications as:

Activities and use of materials to provide information to current and prospective enrollees. This is the more generic of the two categories and does not require CMS review. This can be seen as a loosening of the restrictions.

An example of Communications could be activities/materials that promote awareness of MA plans in general and the fact that you offer that type of plan.

The MCMG defines Marketing as:

Marketing can be considered a subset of Communications and provides more detailed information. Marketing materials are those that could include information on a plan’s benefit structure, cost sharing and measuring or ranking standards. These types of materials are subject to CMS review.

An example of marketing materials would be a flyer that provides specific details about a plan’s benefits, cost sharing or ranking standards.

Put another way, marketing materials are those with an intent to draw a beneficiary’s attention to a MA plan or plans to influence a beneficiary’s decision-making process when selecting and enrolling in a plan or deciding to stay in a plan and contain information about the plan’s benefit structure, cost sharing, and measuring or ranking standards.

30.6 – Electronic communication Policy:

Section 30.6 explains that a sponsor may initiate contact via email to prospective enrollees and to retain enrollment for current enrollees.

It also notes that text messaging and other electronic messaging (social media) is considered unsolicited and is not permitted.

40.2 – Marketing Through Unsolicited Contacts:

As in 30.6 above, Section 40.2 adds email to the list of allowable unsolicited contact methods, as long as there is an opt-out function in the email.

This section also clarifies that unsolicited text messages are not permitted.

50.3 – Personal/Individual Marketing Appointments:

There is no longer any language preventing an agent from asking for referrals during a one on one appointment. (No more excuses)

60.4 – Plan/Part D Sponsor Activities in the Healthcare Setting:

Section 60.4 clarifies that waiting rooms are considered part of the common areas and common areas are approved for sales activities.

It also states that Communication materials may be distributed and displayed in all areas of the healthcare setting.

90.1 – Material Identification:

Section 90.1 includes a new material identification process, as well as guidance on what types of materials will require submission to HPMS.

Note:

The section relating to the rules that apply to referral programs (30.9) has been removed. This will allow for some flexibility in gaining referrals.

If you offer a gift for referrals, just remember, you will still need to abide by the Nominal Gift standards (40.4).

Appendix 2, Disclaimers:

Disclaimers have been simplified and are now located in Appendix 2 of the MCMG. Some of the relevant proposed changes are listed below.

The following disclaimers may be removed from your materials:

“A sales person will be present with information and applications.”

The following disclaimer may be removed from your advertising materials:

“This is an advertisement”

The following disclaimer may be removed from your materials:

“Non- health or non-plan related information”

The following disclaimer may be removed from your materials:

“Medicare has neither reviewed nor endorsed this information.”

You no longer have to put the following text in email subject lines. As long as the material is not considered Marketing.

“Marketing”

Appendix 3, Pre-Enrollment Checklist:

The Pre-Enrollment Checklist was added to consolidate disclaimers on a given plan. The Checklist is designed to help enrollees understand important rules before making an enrollment decision.

Conclusion

This update marks a significant change to the MCMG. There are new additions, several sections have been moved around and others removed entirely.

We recommend reading through the entire guidelines to ensure you’re aware of any possible impact to your business.

We have pre-approved Medicare Marketing Materials as well as carrier approved marketing materials available for our agents.

As always, our experienced marketers are here to answer any questions you may have.

On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) issued long-awaited rules pertaining to, among other matters, the marketing of Medicare Advantage (MA) plans. YourMedicare and its partners had been anticipating these changes and have activated a task force to study the newly published rules in detail and clarify their implications for our affiliated agents’ businesses.

The FAQ is the culmination of that effort. Here you will find answers to a number of questions we have received since April 5, as well as clarification on the new rules our team is proactively providing.

Please bookmark this page for future reference. As new information and interpretations become available, we will add those to this page.