We are in the Medicare Advantage Open Enrollment Period (MA OEP) until March 31, so it is crucial to understand the specific marketing rules that apply during this time.
These rules ensure compliance with Centers for Medicare and Medicaid Services (CMS) regulations to protect beneficiaries and maintain ethical marketing practices.
#What You Can Do
- Host events focused on marketing related to the Continuous Special Enrollment Period (SEP). Agents can talk to people new to Medicare (“age-ins”) who haven’t enrolled in a Medicare health plan yet. You can also have events focusing on the several other SEPs people use to enroll in Medicare year-round, like Chronic Special Needs Plans (CSNP), people losing their creditable Part D coverage, or moving into a new area, SEPs, to mention a few.
- Reach out to dual-eligible and Low-Income Subsidy (LIS) beneficiaries who may qualify for this SEP and are eligible to switch plans. Agents can host events to talk about the LIS program, how it works, and how people can qualify for LIS. You can also help these beneficiaries apply for LIS if you are eligible. Agility can refer agents to resources that assist beneficiaries with the LIS application.
- Send unsolicited communications only when a beneficiary proactively requests information. Agents can continue to reply to client inquiries for help or questions with answers to clients’ questions. You need to make sure the original outreach from your client is attached to your communication to confirm compliance with this rule on your communication.
- Hold one-on-one meetings with beneficiaries who ask for them. If a client asks you for a one-on-one meeting in person, virtually, or over the phone, you can meet with them to discuss whatever they want. This meeting is where your Scope of Appointment documentation is essential to maintain compliance with this CMS rule. The Scope document possesses all the information you need to show for compliant communication with your client, so completing this document is critical for each meeting with your client.
- If a beneficiary directly asks about the MA OEP or their plan options, provide information. When a client requests this information, agents can deliver it to their clients in whatever form the client requests. Remember, clients need to ask you for the information, and you need to document the request for your records.
- Contact former enrollees who made plan changes during the AEP if they initiate the contact. Suppose a former client reaches out to you. In that case, you can talk to them about their inquiry or question(s), documenting your communication with the proper documents like the Scope of Appointment as necessary. This documentation provides agents with confirmation of compliance with the CMS Marketing Guidelines, so remember this is a critical protection for your agency.
#What You CAN’T Do
- Target or send marketing materials to beneficiaries enrolled in MA or Part D plans during the MA OEP (January 1 – March 31). This activity especially applies to beneficiaries who decided during the Annual Enrollment Period (AEP). Agents CAN’T send marketing materials to their current clients through March 31.
- Advertise or participate in agent activities to increase sales through the MA OEP. Agents CAN’T advertise or conduct sales activities related to MA OEP.
- Reach out to beneficiaries unsolicited with messages like:
o “Don’t like your new Medicare Plan? Contact me for disenrollment options.”
o “You can switch your MA plan until March 31—let’s schedule an appointment.”
o “Limited time to make an appointment and switch plans.”
If a beneficiary has not requested your communication specific to MA-OEP, you can’t send them anything about it.
If a beneficiary who has already made an enrollment decision unintentionally receives marketing materials, it is not considered “knowingly targeted.”
Please ensure all communications and marketing efforts comply with these guidelines. If you have any questions or need further clarification about these guidelines, please email our Agility Compliance team at [email protected] for assistance.
