1. Medicare Part C & D Marketing Guidelines & WI Senior Medicare Patrol Updates Fall 2019 Medicare Training for Wisconsin Professionals
Funded by: This project was supported, in part by grant number 90MPPG , from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy

2. Senior Medicare Patrol
The mission is…
to empower and assist Medicare beneficiaries, their families, and caregivers
to prevent, detect, and report health care fraud, errors, and abuse
through outreach, counseling, and education.

3. Medicare Part C & D Marketing Guidelines
Rules that insurance companies and plan representatives (insurance agents and brokers) must follow when selling Medicare Advantage plans, Part D plans, cost plans, employer/union-sponsored group Adv and Part D plans, and Medicare- Medicaid plans (with some exceptions)
Meant to prevent plans from presenting misleading information about plan costs or benefits
Includes rules for how plan representatives may contact and market to beneficiaries

4. Communications vs. Marketing
Communications: activities and materials that provide information to current and prospective enrollees
Marketing: a subset of communications that has the INTENT to influence a beneficiary’s decision about their healthcare coverage and includes marketing information

5. Communications
May not provide inaccurate or misleading information, or engage in activities that could mislead or confuse beneficiaries or misrepresent the plan
May not discriminate based on race, ethnicity, national origin, religion, gender, sex, age, mental or physical disability, health status, receipt of health care, claims experience, medical history, genetic information, evidence of insurability, or geographic location
May not target higher income areas

6. Communications
May not state or imply that plans are only available to seniors rather than to all Medicare beneficiaries
May not claim that they are recommended or endorsed by CMS, Medicare, or the Department of Health and Human Services (DHHS)
May not use the word “free” to describe:
Zero-dollar premium
Reduction in premiums, reduction in deductibles or cost sharing
Low-income subsidy (LIS)
Cost sharing for individuals with dual eligibility

7. Communications
Must include the plan type at the end of each plan name on all communication or marketing materials when the plan name is mentioned
Example: HMO could be named “Golden Medicare HMO” or if named “Golden Medicare Plan”, must add “(HMO)” so that the plan type if clear

8. Marketing
INTENT – to draw a prospective or current enrollee’s attention to a plan or group of plans to influence a beneficiary’s decision when selecting and enrolling in a plan or deciding to stay in a plan (retention-based marketing)
AND
CONTENT – information intended to draw attention to a plan or influence a beneficiary’s enrollment decision, including:
Information about benefits of benefit structure;
Information about premiums and cost sharing;
Comparison(s) to other plans;
Rankings or measurements in reference to other plans;
Information about Star Ratings

9. Educational Events Explicitly advertised as educational
Can include communication activities and distribution of communication materials
Beneficiary-initiated questions can be answered
Can set-up marketing appointment and distribute business cards and contact info for beneficiaries to initiate contact

10. Educational Events “Don’ts”
Cannot include marketing or sales activities
Cannot distribute marketing materials or enrollment forms

11. Marketing/Sales Events
Designed to steer or attempt to steer potential enrollees, or retain current enrollees, toward a Plan or limited set of Plans

12. Marketing/Sales Events Requirements
Must submit presentations, including ones by agents/brokers, to CMS prior to use
Any sign in sheet must be clearly labeled as OPTIONAL
Health screenings or other activities that may be perceived as, or used for, “cherry picking” are not permitted
Contact information provided for raffles or drawing may only be used for that purpose
May not require attendees to provide contact information as a prerequisite for attending

14. Scope of Appointment (SOA)
Scope of appointment documentation is required for all marketing appointments
Discussions during the appointments may only concern previously agreed-upon plan products documented in the SOA

15. SOA Requirements Included on all SOA forms or recorded calls:
Product types to be discussed
Date of appointment
Beneficiary and agent contact information
The following language/statement: “No obligation to enroll, current or future Medicare enrollment status will not be impacted, and automatic enrollment will not occur.”
A new SOA is required if, during an appointment, the beneficiary requests information regarding a different plan type than previously agreed upon.

16. Marketing Timing
Plans cannot begin marketing for the Fall Annual Enrollment Period (October 15 – December 7) until OCTOBER 1 each year

17. Contacting Beneficiaries During Fall AEP
Plans are allowed to send a beneficiary unsolicited mail and , but must have an opt-out option
Unless an individual is currently enrolled in an insurance company’s plan or has given permissions, plans are not allowed to:
Contact individuals by phone, text message or social media
Visit individuals
Leave promotional materials at an individual’s home
Approach individuals in public to market the plan

18. Contacting Beneficiaries by Phone

19. Tips for Clients during Fall AEP
No need to make a decision immediately!
Read current plan’s Annual Notice of Change of Explanation of Coverage to learn about changes
Contact plan to request a copy if not mailed
Contact plan with any questions and ask for confirmation of the benefits in writing

20. How can the Wisconsin SMP help?
Education
Referrals

21. SMP Education
Updated current educational message to include information about Medicare marketing guidelines
Fraud Alert Issued September 2019
Periodic Facebook posts providing information and reminders

22. SMP Referral Process
For suspected marketing violations, SMP referrals go to the CMS SMP liaison
If an insurance agent is involved in the suspected violation, SMP also submits complaint to the WI Office of the Commissioner of Insurance (OCI)

23. Information requested for SMP Referral
The more information, the better!
Copies of mailing received
Copies of received, including attachment(s)
Agent name, company name, and phone number

24. Examples of Cases Referred to CMS Liaisons
Agent in van at grocery store parking lot
Sign-up sheets at educational events
Providing meals to prospective enrollees
Agents misrepresenting their purpose to present at Senior Centers
Genetic testing companies claiming Medicare plan coverage

25. WI SMP Updates

26. What are we seeing in Wisconsin?
SSA & Medicare Telephone Scams
Durable Medical Equipment Scams
Genetic Cancer Screening Scams
Marketing Guidelines & Violations
What are the new scam trends, nationwide?
Hearing Aids
Physician Kick-Backs

27. SMP Resources Available
Educational Presentations and Outreach Events (Expos, Wellness Fairs, etc.)
Helpline (888)
Personal Health Care Journals
Quarterly Newsletter, The Scoop

28. How SMP Thrives Volunteer Support
Distribute Information & Materials
Give Presentations (like this one!)
Staff a Table at Events & Fairs
Join the SMP program as a volunteer!

29. Contact Wisconsin SMP Greater Wisconsin Agency on Aging Resources (GWAAR)
Visit us online:
Like us on Facebook: @WisconsinSeniorMedicarePatrol
Send an
Call Toll-free:
To report suspected fraud/abuse
For training, speakers, and/or materials
To volunteer with the SMP program