AEP SEASON STARTS TOMORROW! Here Are Some Compliance Tips to Keep You Safe And Stress Free This Season.

October 15 is a big day for those in the senior market. The Medicare Annual Enrollment Period – AEP for short – is a set time each year for changing your Medicare coverage choices if you choose to. AEP runs from October 15 to December 7 and new coverage choices go into effect on January 1 2023.

For many carriers, lead generators, and Medicare agents, AEP is a very stressful time of the year — and that is why we’ve been gearing you up for it.

As I discussed earlier this year, the Centers for Medicare & Medicaid Services (CMS) released several new compliance rules that went into effect in June 2022 – making it even more stressful for folks in Medicare.

Here are some important reminders to help get you through this AEP season in a compliant way:

  1. New Disclaimer: Include the following disclaimer on all your MA plans/Part D marketing materials (print, radio, websites, BRCs, electronic etc.), in the first minute of all sales calls & in all electronic communications: “We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.” Note CMS is requiring this disclaimer for ALL websites regardless of whether it is marketing or communication.
  2. Call Recordings: All calls with beneficiaries must be recorded and stored calls for 10 years. The requirement is for all calls between a TPMO (including lead generators) and a beneficiary.
  3. Vendor – TPMO Compliance: You must ensure that all vendors you are using related to the chain of enrollment are following the Third Party Marketing Organization guidelines– TPMO for short — guidelines. Lead generators are included in the definition of TPMOs. This new rule was specifically put into place by CMS to capture folks that were outside CMS’ regulatory framework.
  4. Marketing Material Submissions: If you are creating your own marketing materials, you must submit all marketing materials to CMS and carriers and get them approved.
  5. TPMO Guidelines: Plans must ensure TPMOs conducting lead generation activities will inform beneficiaries that his or her information will be provided to a licensed agent for future contact or the call will be transferred to a  licensed insurance agent who can conduct enrollment.
  6. PTC: PTC is permission given by the consumer to be called or otherwise contacted by a representative of a Medicare provider for the purpose of marketing a Medicare Solutions product. No unsolicited phone calls are permitted without PTC. But don’t forget – a consumer’s consent may very easily constitute PTC but absolutely not constitute as PEWC under the TCPA.
  7. SMID: All marketing materials must be filed in the Health Plan Management System (HPMS) to receive a Standardized Material Identification (SMID) code – a user created unique identifier to indicate approval for the marketing material. HPMS is CMS’ primary tool for reviewing and approving marketing content. CMS defines “marketing” materials with the “intent to draw a beneficiary’s attention to a plan or plans and to influence a beneficiary’s decision-making process when selecting a plan for enrollment or deciding to stay enrolled in a plan (that is, retention-based marketing).”

The question I am repeatedly asked is “How will compliance be regulated?” We suspect CMS will be closely monitoring consumer complaints received through its hotline and will establish strict timeframes for assigning, researching and resolving complaints  If CMS receives a consumers complaint for a plan that you sold, expect CMS to investigate and hold you responsible for reaching out to the agent of record to obtain further information such as – call recordings, vendor information, PTC, SMID, etc. CMS really wants unscrupulous marketing practices to stop—and it is serious about it as indicated by the new Final Rule. And you can expect CMS to issue cease and desist orders, sanctions/fines and even license suspensions.

So if you are buying leads this AEP season – you MUST make sure those leads are being compliantly generated, meaning that they are generated through CMS approved marketing materials OR generated through materials deemed “communications” per the CMS guidelines. If your lead vendor doesn’t know what a “SMID” is or how to obtain one that is a really great indicator you shouldn’t be working with that vendor.

Stay compliant this AEP season, TCPAWorld.

 

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