Take Advantage of the 2024 Final Rule to increase Your Medicare Advantage Plan and Prescription Drug Plan Sales

The 2024 Final Rule brings more formality and structure to the way agents and brokers must do business. CMS explains these changes as a way to provide better information to beneficiaries and prevent agents from misleading beneficiaries. Overall, the CMS Final Rule for Contract Year 2024 are deemed positive for beneficiaries. These changes challenge us to refine how we position ourselves in the marketplace. We will look at the new rules and discuss how to use them effectively and improve our sales process.

CMS has made the following changes to the TPMO Discloure

Manage How the TPMO Disclosure Influences Your Clients

Use the Scope of Appointment Wait Period As Part of Your Educational Process

Revise Marketing Best Practices For Medicare Advantage Plans and Medicare Part D Plans

Three MoreThings You Should Know About the 2024 Final Rule

The Centers for Medicare & Medicaid Services (CMS) finalized the Final Rule for Contract Year 2024, outlining key changes that will impact sales processes. These changes include modifications to the third-party marketing organization (TPMO) Disclaimer and additional requirements for independent agents. Outside of the Disclaimer statement itself, agents are free to clarify the significance of the Disclaimer language.

CMS has made the following changes to the TPMO disclaimer:

• Added a requirement that TPMOs must list the names of MA organizations or Part D sponsors which they represent in the applicable service area. This frees agents to disclose information previously encumbered by MA organizations.

Added a requirement that TPMOs must state, “We do not offer every plan available in your area.” if they only sell for some, not all of the MA organizations or Part D sponsors in a service area.

• Added a requirement that TPMOs must modify their disclaimer to add State Health Insurance Programs (SHIPs) as a source of information to beneficiaries.

In addition to these changes to the TPMO disclaimer, CMS has also added the following requirements for independent agents:

• Requires 48 hours between the time of signing a Scope of Appointment (Scope of Appointment) and an appointment.
• Limits how long Scopes of Appointments and Business Reply Cards are valid.
• Clarifies the prohibition on door-to-door contact.
• Defines the requirement to record calls.
• Clarifies call recording includes virtual calls.
• Requires additional elements prior to enrollment.

The changes to the TPMO disclaimer are particularly significant, as they require TPMOs to be more transparent about their business practices and to provide beneficiaries with more information about the plans they offer. This is presumed to help beneficiaries make more informed decisions about their Medicare coverage and avoid being misled by marketing claims.

Revise Marketing Best Practices for Medicare Advantage Plans and Medicare Part D Plans

The changes to the requirements for independent agents are also significant, as they will require agents to follow “best practices” when marketing Medicare plans. Many of those best practices were included in enrollment materials previously. Some of the “new best practices” are refinements of existing materials and streamline the sales presentation. However, we must be consistent in going through every element of the

. Manage How the TPMO Disclosure Influences Your Clients

• The new requirement that TPMOs must list the names of MA organizations or Part D sponsors which they represent in the applicable service area may help beneficiaries to identify which TPMOs are authorized to sell plans in their area. This will help beneficiaries know which TPMOs are not authorized to sell specific plans in their area. Agents may clarify their organization choices in terms of the market strategies they follow. Agents can use the Clinebell TPMO Disclosure page to showcase their plan inventory. See www.Clinebell.com.
• The new requirement that TPMOs must state, “We do not offer every plan available in your area.” if they only sell for some of the MA organizations or Part D sponsors in a service area. This is presumed to help beneficiaries understand that they may not be able to purchase all of the plans that are available in their area through a particular TPMO.  Shopping around may be unnecessary if beneficiaries are educated properly. Then they can determine how an agent represents enough different plans to meet their needs.
• The new requirement that TPMOs must modify their disclaimer to add State Health Insurance Programs (SHIPs) as a source of information to beneficiaries will help beneficiaries to learn more about SHIPs and how they can get help from SHIPs with their Medicare coverage. The TPMO Disclosure does not explain the limitations of SHIP or Medicare.gov in the enrollment process. Brokers may explain the differences between the service brokers offer and those of SHIP and Medicare.gov.

Use the Scope of Appointment Wait Period as Part of Your Educational Process

• The new requirement is that independent agents must wait 48 hours between a Scope of Appointment and an appointment is intended to give beneficiaries time to review the Scope of Appointment and to ask any questions they have before an appointment with an agent. There is no opt-out for beneficiaries from this restriction. This “wait” is presumed to help beneficiaries make more informed decisions about their Medicare coverage. However, Medicare.gov and SHIP are not bound by the SOA rules. Agents may use this period for educational activities, completing a factfinder and doing homework for plan recommendations.
• The new limits on how long Scope of Appointments and Business Reply Cards are valid presumably will help ensure beneficiaries are not using outdated information when making decisions about their Medicare coverage. It is not clear how beneficiaries would be given outdated information. It will be necessary to get a new SOA each year before working with clients. To ensure compliance, a record of clients and the signature date of their SOA could be kept.

Three MoreThings You Should Know About the 2024 Final Rule

• The additional elements that are required prior to enrollment include strict attention to the pre-enrollment checklist. Recorded calls document whether we have reviewed the items in the checklist.
• The clarification of the prohibition on door-to-door contact intended to protect beneficiaries from being harassed by salespeople at their homes.
• The limits on the requirement to record calls and the clarification that call recording includes virtual calls is intended to protect beneficiaries’ privacy.

Overall, the changes to the CMS Final Rule for Contract Year 2024 requires us to follow a more structured approach to our sales process. One benefit is the disclosure of our contacted organizations. This strengthens our marketing materials nicely. We must be sensitive to the potential for audits of our recorded conversations. We should review what is and is not considered compliant topics.