It’s that time of the year again – THE START OF AEP SEASON 2025!
As you may know, the Medicare Annual Enrollment Period (AEP) is a crucial time for millions of Americans who rely on Medicare for their healthcare needs. AEP, which runs from October 15th to December 7th each year, is the time when beneficiaries can make changes to their Medicare coverage for the upcoming year.
AEP marketing and advertising is governed by the Centers for Medicare & Medicaid Services (CMS) – and understanding the compliance requirements CMS has been putting forth the last few years is crucial to having a successful and compliance AEP Season.
As a reminder, last year, we saw quite a few significant changes to CMS’ new rules – and this season is no different.
So what’s key for 2025?
- NEW TELEMARKETING GUIDINES: New for the 2025 season – CMS has issued a significant rule regarding prior express written consent requirements on TPMOs, INCLUDING lead generators. This ruling already went into effect on October 1, 2024 – which requires TPMOs to obtain prior express written consent from beneficiaries before sharing their data with other TPMOs for marketing purposes. If you are reaching out via phone call or text messages, you are required to follow CMS’ and FCC’s new prior express written consent definition prior to sharing personal data with TPMOS!
- SOCIAL MEDIA COMPLIANCE: CMS requires you to be transparent in all marketing. CMS has prohibited the use of the term “Medicare” in website domains, in your business name and other company branding marketing materials – CMS also prohibits the use of the red, white and blue Medicare card and any official government logos. If you are an independent agent, agency or broker with no affiliation to the federal government, you must clearly communicate so. Independent agents can take advantage of pre-approved marketing materials provided by insurance carriers, including brochures, flyers, and social media posts that have already been vetted for compliance with CMS Medicare Marketing guidelines.
- 12-HOUR EDUCATIONAL EVENT RULE: Agents cannot distribute Scope of Appoints (SOAs) or set appointments at Medicare educational events – they may however hand out Permission to Contact (PTC) forms, Business Reply Cards (BRC) and business cards. Importantly, a marketing event cannot take place within 12 hours of an educational event at the same location. This guideline was set to maintain a clear distinction between educational and promotional activities to ensure attendees receive unbiased information from you.
- MEDICARE SALES AND MARKETING EVENTS: At marketing events, Plan/Part D Sponsor may promote specific benefits/premiums and services offered by the plan. Plans/Part D Sponsors may also accept enrollment forms and perform enrollment at marketing events. BUT you cannot require attendees to provide their contact information or maintain a sign-in sheet. Attendees can however voluntarily share their contact details if they wish to receive more information or set up an appointment.
- THE 48 HOUR RULE: One of the major changes from 2024 included the requirement of a mandatory minimum 48-hour Scope of Appointment (SOA) cooling-off window. This is still in place for 2025. When marketing Medicare Advantage or Prescription Drug Plans, agents must follow SOA requirements. They are not allowed to discuss products outside the scope of the appointment without the beneficiary’s consent. However, the 48 hour rule does not apply: i) when a beneficiary reaches out to you directly via an inbound call; ii) if a beneficiary visits your office in person; and iii) when a beneficiary is within four days of the end of a valid election period.
- SOA FORMS: SOAs are good for 12 months from the date the beneficiary signs up. These forms must be kept on file for 10 years. If an appointment is made through an inbound call, the SOA should be communicated verbally and documented accordingly.
- ANNUAL OPT OUT REQUIREMENTS: remember, Medicare plans must notify enrollees annually in writing of their ability to opt out of phone calls. This is to ensure beneficiaries are fully informed about their preferences and can choose whether to continue to receive communications.
- “CALL” RECORDING: This rule is still in place folks. It is mandatory to record all sales and marketing communications conducted via telephone, including on platforms such as Zoom or Skype.
- DISCLAIMER REQUIREMENT: Do not forget about this low hanging fruit. The following disclaimer must be added to your websites, digital and print materials, email signatures, chat communications, and all marketing materials if you are a TPMO that does not sell all MA and/or Part D plans within a service area: ““We do not offer every plan available in your area. Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all your options.” If you do sell within a service area the disclaimer is as follows: “Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. You can always contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) for help with plan choices.” Note, agents must also add this to their script within the first minute of a phone call to a beneficiary.
- GENERAL MARKETING COMPLIANCE: CMS provides a Medicare and Communications Marketing Guideline that must be adhered to. Consider implementing at minimum the following best practices on your websites and marketing materials: include all required disclaimers, clearly indicate that a licensed agent will reach out to the consumer after they submit their lead information, do not use carrier logos, do not use “Medicare” in your URL or domain name, keep your content general and avoid detailing specific plan offerings, avoid promoting benefits that are not generally included in most plans (dentures, free eyeglasses etc.), avoid promoting cost savings that are not typical, without qualifying language, do not use scare tactics or create a false sense of urgency to act now, avoid any Affordable Care Act references with respect to Medicare products, refrain from using the term “senior” unless permissible, and avoid otherwise misleading, confusing, or materially inaccurate information.
Now these are only Queenie’s top 10 of the new marketing rules established by CMS.
Stay compliant this AEP season, TCPAWorld.